The Credentialing Specialist will ensure that appropriate processes are in place to monitor and maintain systematic, timely credentialing and re-credentialing of network providers. Performs a meticulous review of health provider’s qualifications, Submits the information with necessary applications to insurance companies and other payers.

 Essential Duties and Responsibilities

• Initiate and complete the provider enrollment credentialing and recredentialing process for physicians.
• Assist providers in completion of various applications for managed care participation.
• Ensure provider practice addresses are current with health plans.
• Update and provide quarterly rosters to payers in accordance with their policies and procedures.
• Audit health plan directories for current and accurate provider information.
• Maintain timely and accurate data entry of provider data in CAQH.
• Monitor expiring licensure, board and professional certifications and other documents that expire for all providers and ensure timely renewals.
• Assist in trouble-shooting provider plan participation interruptions and other member related issues.
• Assist and maintain internal fee schedules for North and South Carolina.
• Adhere to policies and procedures including data security, confidentiality and timely delivery of completed work.
• Other duties as assigned.

 Requirements

• 2-3 years of credentialing experience
• Ability to meet deadlines and prioritize.
• Knowledge of provider credentialing requirements
• Ability to manage multiple projects effectively.
• Ability to analyze, interpret and synthesize a wide range of information, including legal and contract language, policies, standards and guidelines.
• Represents the office/Organization in a positive manner.
• Possess analytical and problem-solving skills.
• Must maintain patient/client confidentiality.

Physical Requirements
Must be able to sit for long periods of time and work in a fast-paced office environment. Should be able to bend and lift up to 10 lbs.

Reports to: Director of Operations