What are the responsibilities and job description for the Credentialing Specialist position at Southern Orthocare?
We are seeking a detail-oriented and organized Credentialing Specialist to join our team. The Credentialing Specialist is responsible for coordinating and maintaining provider credentialing, recredentialing, and enrollment activities to ensure compliance with regulatory, accreditation, and payer requirements. The ideal candidate will have strong administrative skills, excellent attention to detail, and experience working with healthcare providers and insurance payers.
Key Responsibilities
- Manage the credentialing and recredentialing process for healthcare providers.
- Prepare and submit credentialing applications to insurance payers.
- Monitor credential expiration dates and ensure timely renewals.
- Maintain accurate provider records and credentialing databases.
- Follow up with providers, payers, and licensing boards regarding application status and required documentation.
- Ensure compliance with federal, state, and accreditation standards.
- Assist with provider enrollment and contracting processes.
- Support other departments as needed
Qualifications
- High school diploma or equivalent required; Associate's or Bachelor's degree preferred.
- Minimum of 1–2 years of credentialing experience in a healthcare setting preferred.
- Knowledge of healthcare credentialing, provider enrollment, and insurance payer requirements.
- Familiarity with Medicare, Medicaid, and commercial payer enrollment processes.
- Strong organizational and time-management skills.
- Excellent written and verbal communication skills.
- Proficiency with Microsoft Office Suite and credentialing software.
- Ability to manage multiple priorities while meeting deadlines.