Healthcare Provider Credentialing Specialist

This highly skilled position plays a critical role in the provider credentialing process, ensuring timely and accurate submissions, seamless onboarding, and compliance with all relevant regulations.

• Provider Enrollment & Application Management:
  • Demonstrated expertise in end-to-end provider enrollment processes, including proficiency in completing high volumes of applications across various specialties and payer types.
  • Timely and efficient submission of completed applications to relevant entities, tracking application statuses, and proactively following up on outstanding items to expedite approval.
• Welcome Kit Generation & Contract Loading:
  • Responsible for creating comprehensive Welcome Kits for new providers, ensuring all necessary documentation and information is included.
  • Accurate and efficient loading of provider contracts into designated systems, capturing all terms and conditions correctly.
• Application Portal Expertise:
  • Extensive experience in managing accounts within key healthcare application portals, including CAQH, Medicaid, Medicare (PECOS), and NPI portals, maintaining ethical standards in data handling.
• Communication & Responsiveness:
  • Maintaining a high level of professionalism and responsiveness in email communications, promptly addressing queries and providing clear, concise information to internal and external stakeholders.
• Compliance & Confidentiality:
  • Strict adherence to HIPAA regulations and maintaining the utmost confidentiality of sensitive patient and provider information.
  • Ensuring all credentialing activities are in full compliance with federal, state, and organizational guidelines.

• Excellent Communication and Interpersonal Skills: Demonstrating exceptional ability to convey information clearly, concisely, and effectively, both verbally and in writing.
• Ability to Work Independently and as Part of a Team: Exhibiting strong initiative and self-motivation, capable of managing tasks and responsibilities autonomously with minimal supervision.
• Proficiency in Google Sheets and Docs: Highly skilled in utilizing Google Sheets for data organization, analysis, and visualization, including complex formulas, pivot tables, and charts.
• Excellent Typing Skills: Possessing high accuracy and speed in typing, significantly contributing to efficient data entry, document creation, and overall productivity.
• Comprehensive Knowledge of Computer Usage and Navigation: Displaying thorough understanding of operating systems, common software applications, and internet browsers.

• Education:
  • Bachelor's Degree in a relevant major such as Healthcare Administration, Health Information Management (HIM), Business Administration, or Public Health.
  • Associate's degree combined with relevant work experience may suffice for entry-level roles.
• Experience:
  • Expertise in provider enrollment and credentialing processes, ensuring ethical and accurate completion and submission of applications across various specialties and payers.
  • Proficiency in managing accounts in CAQH, Medicaid, Medicare (PECOS), and NPI portals, maintaining ethical standards in data handling.
  • Familiarity with state-specific regulations and payer requirements, maintaining integrity in compliance.
• Technical Skills:
  • High proficiency in Google Sheets and Google Docs, supporting high-performance culture through efficient workflows.
  • Excellent typing skills for precise data entry, contributing to operational excellence.
  • Strong knowledge of operating systems, software, and browsers to uphold professional performance standards.
• Compliance & Ethics:
  • Strict adherence to HIPAA regulations and maintaining the utmost confidentiality of sensitive information.
  • Ensuring all credentialing activities are in full compliance with federal, state, and organizational guidelines.

• Clear, Professional, and Ethical Communication: Verbal and written communication that fosters trust and clarity.
• Organization: Timely submissions and diligent tracking of application statuses.
• Independence & Teamwork: Autonomy with ethical initiative and effective collaboration.
• Attention to Detail: Accurate application and contract management, reflecting commitment to quality and precision.