Credentialing Specialist

The Credentialing Executive will be responsible for the management of the credentialing and re-credentialing processes for healthcare providers, ensuring that all provider data is accurate, complete, and in compliance with federal, state, and payer guidelines. This position plays a critical role in maintaining the integrity of our healthcare network and contributing to our mission of delivering exceptional care.

Role & responsibilities

• Oversee the complete credentialing lifecycle for healthcare providers, including initial credentialing, re-credentialing, and ongoing monitoring.
• Ensure compliance with accreditation bodies, government regulations, payer requirements, and organizational policies.
• Review and verify the education, licensure, certifications, and work history of healthcare providers.
• Maintain accurate and up-to-date provider files and databases.
• Database Management: They maintain accurate records and databases of healthcare providers' credentials and documentation, making this information accessible to the organization's leadership and relevant departments
• Communication: Credentialing Specialists liaise with healthcare providers, administrative staff, and regulatory authorities to ensure all requirements are met
• Reappointment: They manage the re-credentialing or reappointment process, ensuring that healthcare providers remain in compliance with all requirements for continued practice
• Good knowledge in filling insurance enrollment applications.
• Good experience in CAQH, PECOS applications.
• Experience in Medicare, Medicaid, Commercial insurance enrolment.