Credentialing Specialist

Purpose - The Credentialing Specialist supports the accurate and timely credentialing and recredentialing of healthcare providers with insurance networks, clearinghouses, and other credentialing bodies. This role involves maintaining compliance, ensuring accurate documentation, and coordinating with insurance networks and other credentialing entities.

Key Responsibilities

Credentialing and Recredentialing Support:

• Preparing, submitting, and tracking provider enrollment applications for insurance networks and credentialing organizations.
• Ensure the accuracy and completeness of provider credentialing documentation, including licenses, certifications, and insurance coverage.
• Monitor and update credentialing timelines, ensuring compliance with deadlines and payer requirements.

Compliance and Documentation:

• Perform primary source verifications as directed, maintaining adherence to regulatory and organizational standard...