What are the responsibilities and job description for the Credentialing Specialist position at Innovative RCM LLC?
Job Overview
We are seeking a detail-oriented and proactive Credentialing Specialist to join our dynamic healthcare team. In this vital role, you will oversee the credentialing and re-credentialing processes for healthcare providers, ensuring compliance with industry standards and regulatory requirements. Your expertise will help maintain the integrity of provider credentials, support smooth operational workflows, and uphold the organization’s commitment to delivering high-quality care. This position offers an exciting opportunity to contribute to a thriving healthcare environment by ensuring providers are properly credentialed and compliant with all necessary standards.
Duties
- Manage the end-to-end credentialing process for new healthcare providers, including verifying licensure, certifications, and educational background
- Maintain accurate and up-to-date provider records in accordance with NCQA (National Committee for Quality Assurance) standards and managed care requirements
- Collaborate with insurance payers, licensing boards, and other external agencies to facilitate credentialing and re-credentialing activities
- Review and interpret medical documentation, professional licenses, and related credentials using medical terminology to ensure accuracy and completeness
- Monitor expiration dates of credentials and proactively initiate renewal processes to prevent lapses in provider eligibility
- Assist in preparing documentation for audits related to credentialing compliance and managed care accreditation standards
- Support onboarding processes by coordinating with medical offices to gather necessary documentation and ensure timely credential approval
Skills
- Prior experience working in a medical office environment or healthcare setting with exposure to credentialing procedures preferred
- Excellent knowledge of medical terminology to accurately interpret provider credentials and documentation
- Detail-oriented with exceptional organizational skills to manage multiple provider files simultaneously
- Effective communication skills for liaising with external agencies, providers, and internal teams
- Ability to navigate healthcare management systems and databases efficiently
- Proactive problem-solving skills to address credentialing issues promptly
Join us in ensuring our healthcare providers are credentialed accurately and efficiently! This role is perfect for motivated professionals eager to make a meaningful impact on healthcare quality through diligent credential management. We value your expertise in maintaining compliance standards while supporting our mission of delivering exceptional patient care.
Job Type: Full-time
Pay: $16.00 - $18.00 per hour
Expected hours: 40 per week
Benefits:
- 401(k)
- Paid time off
Work Location: In person
Salary : $16 - $18