Credentialing Specialist

Full Time
Posted 7 years ago

Job Description:

This position reports to the Director of Billing and will have the potential to grow within the company. We are looking for a positive person who is interested in achieving success and will help take our company to the next level of service. The seasoned professional for this job needs superior communication and computer skills.



Responsible for all aspects of the credentialing, re-credentialing and privileging processes for medical providers who provide patient care at our client facilities. Responsible for ensuring providers are credentialed, appointed, and privileged with health plans, hospitals and patient care facilities. Maintains up-to-date data for each provider in credentialing databases and online systems; ensures timely renewal of licenses and certifications. Essential functions include:

  1. Compiles and maintains current and accurate data for all providers, ensuring confidentiality of personal information.
  2. Completes provider credentialing and re-credentialing applications; monitors applications and follows up as needed.
  3. Tracks and maintains copies of current state licenses, DEA certificates, malpractice coverage and any other required credentialing documents for all providers.
  4. Maintains corporate provider contract and credentialing files.
  5. Maintains knowledge of current health plan and agency requirements for credentialing providers.
  6. Sets up and maintains provider information in online credentialing databases and systems.
  7. Tracks license and certification expiration for all providers to ensure timely renewals.
  8. Ensures practice addresses are current with health plans, agencies and other entities.
  9. Processes applications for appointment and reappointment of privileges.
  10. Provides credentialing and privileging primary source verification.
  11. Performs other duties as assigned.



High school diploma or equivalent. Associate degree preferred.



Two years of relevant credentialing experience. Certified Provider Credentialing Specialist (CPCS) preferred.

Job Features

Job CategoryCredentialing Specialist

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