Credentialing Specialist

The Credentialing Specialist is responsible for maintaining active status for all providers by successfully completing initial and subsequent credentialing packages as required by SBCHC, commercial payers, Medicare and Medicaid.

The Credentialing Specialist is responsible for maintaining active status for all providers by successfully completing initial and subsequent credentialing packages as required by SBCHC, commercial payers, Medicare and Medicaid.

• High school graduate or equivalent
• 2 years credentialing experience preferred
• Knowledge of provider credentialing and its direct impact on the practice’s revenue cycle
• Excellent computer skills including Excel, Word, and Internet use
• Detail oriented with above average organizational skills
• Plans and prioritizes to meet deadlines
• Good oral and written communication skills
• Ability to deal professionally, courteously and efficiently with the public and all levels of the organization
• Ability to handle multiple projects simultaneously
• Ability to operate computer, copier, fax
• Proficient in practice management system and Microsoft Office software applications
• Knowledge of HIPAA guidelines and requirements

• Maintain individual provider files to include current information needed to complete the required SBCHC and insurance credentialing applications.
• Maintain internal provider list to ensure all information is accurate and logins are available.
• Update and maintain accurate profiles for each provider’s CAQH, PECOS, NPPES, CMS
• Complete revalidation requests in a timely manner.
• Complete credentialing applications to add providers to commercial payers, Medicare, and Medicaid and new facilities.
• Complete re-credentialing applications for all payers.
• Work closely with the billing manager and billing staff to identify and resolve any denials issues related to provider credentialing.
• Work special projects assigned by billing manager.
• Other duties as assigned
• Cross trained to provide billing department coverage in any task needed to meet end of the month deadlines.
• Responsible for staying current with the rules and updates or changes in state and federal regulations.
• Continually search for ways to improve the accounts receivable process, striving for efficiency in daily operations.
• All Health Center staff members have emergency and disaster response responsibilities. Participates in all safety programs which may include assignment to an emergency response team.