The Credentialing Specialist is responsible for maintaining active status for all providers by successfully completing initial and subsequent credentialing packages as required by hospitals, surgery centers, commercial payers, Medicare and Medicaid.

Duties/Responsibilities:

• Maintain individual provider files to include up to date information needed to complete the required governmental and commercial payer credentialing applications
• Maintain internal provider grid to ensure all information is accurate and logins are available
• Update each provider’s CAQH database file timely
• Apply for and renew annually all provider licenses; Professional, DEA, Controlled Substance
• Complete revalidation requests issued by government payers
• Complete credentialing applications to add providers to commercial payers, Medicare, and Medicaid
• Complete re-credentialing applications for commercial payers
• Credential new providers and re-credential current providers with hospitals at which they hold staff privileges
• Work closely with the billing staff to identify and resolve any denials or authorization issues related to provider credentialing
• Maintain accurate provider profiles on CAQH, PECOS, NPPES, and CMS databases
• Maintain provider directory updates
• Review and annotate payer contracts prior to submitting to management
• Manage and maintain contract spreadsheet
• Performs other duties as necessary or assigned.

Required Skills/Abilities:

• Excellent organizational skills and attention to detail.
• Excellent written and verbal communication skills.
• Ability to follow verbal and written instructions.
• Ability to type at least 40 words per minute.
• Proficient in Microsoft Office Suite.

Education and Experience:

• High School Diploma or GED
• Two years credentialing experience required
• Two years’ experience in a medical practice business office role required