Credentialing Support Specialist

Complete credentialing and re-credentialing applications, tracking and initiating renewals at least 60 days before expiration
Maintain records of credentialing communications, submissions, and approvals
Communicate proactively with payors throughout credentialing cycles
Verify and audit provider directory information in payor databases
Audit internal credentialing databases
Coordinate urgently with facilities to complete overdue re-credentialing requirements
Support internal and external communications that accelerate the credentialing process
Prepare rosters for submission to payors
Collect, verify, and organize documentation for applications with the Administrator Managed Care Credentialing
Troubleshoot and resolve issues hindering timely plan participation
Anticipate three-year re-credentialing requirements and support timely completion
Provide administrative and project support to the Managed Care Department
Support the Managed Care Team and PAM Health facilities with credentialing follow-up
Promote PAM Health's mission and vision
Maintain confidentiality and comply with applicable policies and procedures
Participate in OSHA-required training and follow applicable safety and employee health requirements
Report unsafe practices and understand one's role in emergencies

• Associate's Degree in Health or Business Administration preferred
• High School diploma or GED with two (2) or more years of relevant work history will be considered
• Two (2) or more years of experience in healthcare enrollment, credentialing, or medical practice operations
• Experience in a role requiring high-volume data collection and stakeholder communication
• Strong proficiency with MS 365 applications (Excel, Word, Outlook, PowerPoint) and PDF editing
• Ability to multitask across multiple markets and facilities
• Critical thinking and problem-solving ability
• Time management and prioritization skills
• Professionalism and exceptional interpersonal, written, and verbal communication skills
• Basic familiarity with Insurance Plans and Medical Databases
• Ability to adhere to strict confidentiality guidelines and operate with integrity and discretion
• Knowledge of commonly used credentialing concepts, practices, and procedures, including Primary Source Verifications, Designated Equivalency Sources, and Malpractice History
• Ability to function independently with minimal direct supervision
• PESC certificate through applicable organization is a plus
• Healthcare facility enrollment experience preferred

Demonstrates expertise in credentialing processes, including application management, provider directory verification, and compliance with confidentiality guidelines. Proficient in stakeholder communication and data management within healthcare enrollment and medical practice operations.

• Credentialing Experience
• High-Volume Data Collection
• MS 365 Proficiency
• Critical Thinking
• Healthcare Enrollment Knowledge

• Credentialing
• Data Collection
• Provider Directory Verification
• Primary Source Verification
• Malpractice History Knowledge

• Time Management
• Problem-Solving
• Interpersonal Communication
• Written Communication
• Verbal Communication

• PESC Certificate

• Healthcare Enrollment
• Credentialing Concepts
• Managed Care
• Insurance Plans
• Medical Databases

• MS Excel
• MS Word
• MS Outlook
• MS Power Point
• PDF Editing Software