Spec. Payer Relations

Job Summary

The Payer Relations Specialist coordinates and performs all aspects of the provider credentialing and recredentialing process to ensure healthcare providers meet regulatory, accreditation, and payer participation requirements. Supports compliance with federal and state regulations, accreditation standards, and internal policies by verifying provider qualifications, maintaining accurate credentialing records, and ensuring timely submission and approval of credentialing applications.  Collaborates closely with Medical Staff Services, Revenue Cycle, Compliance, and Payer Enrollment teams to ensure providers are credentialed and approved prior to rendering services and billing for services.

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Minimum Job Requirements:

Work Experience:

Two years of experience as a physician credentialing within a hospital or healthcare system.

License/Registration/Certification:

None

Education and Training:

High school diploma or equivalent required.

Associate’s degree in Healthcare Administration, Business Administration, or related field preferred.

Skills:

1. Ability to understand provider credentialing and recredentialing standards, processes, and verification requirements.
2. Knowledge of federal, state, payer, and accreditation standards affecting provider credentialing.
3. Knowledge of primary source verification methods and documentation requirements.
4. Familiarity with credentialing software and provider databases, including CAQH, PECOS, TMHP, and NPPES.
5. Knowledge of provider licensure, certification, education, and professional history documentation.
6. Strong attention to detail and document management skills to ensure complete and audit‑ready credentialing files.
7. Ability to manage multiple credentialing files and deadlines simultaneously in a regulated healthcare environment.
8. Skill in maintaining accurate, organized, and compliant credentialing records using standardized checklists.
9. Ability to identify discrepancies and resolve credentialing issues through analysis and problem‑solving.
10. Strong written and verbal communication skills to interact effectively with providers, payers, and internal teams.
11. Ability to explain credentialing requirements, timelines, and processes clearly to diverse stakeholders.
12. Ability to collaborate cross‑functionally with other departments.
13. Proficiency with Microsoft Office applications (Word, Excel, Outlook) for tracking, reporting, and documentation
14. Ability to adhere to confidentiality, HIPAA, and compliance standards when handling sensitive provider information
15. Ability to adapt to regulatory changes and apply updated credentialing requirements consistently