Senior Credentialing Specialist

Key Responsibilities

Credentialing and Recredentialing Support:

* Assist the Senior Credentialing Specialist in preparing, submitting, and tracking provider enrollment applications for insurance networks and credentialing organizations.

* Ensure the accuracy and completeness of provider credentialing documentation, including licenses, certifications, and insurance coverage.

* Monitor and update credentialing timelines, ensuring compliance with deadlines and payer requirements.

Compliance and Documentation:

* Perform primary source verifications as directed, maintaining adherence to regulatory and organizational standards.

* Maintain organized credentialing records and ensure accurate data entry in credentialing software or databases.

* Assist in audits of credentialing files to verify compliance with HIPAA and other regulatory requirements.

Communication and Coordination:

* Act as a liaison between the Senior Credentialing Specialist, healthcare providers, and external entities to resolve credentialing-related issues.

* Follow up with providers, payers, and clearinghouses to gather required information or clarify discrepancies.

* Communicate updates on credentialing processes and progress to the Senior Credentialing Specialist and management.

Administrative Support:

* Provide support during high-volume credentialing periods, including managing overflow tasks as assigned by the Senior Credentialing Specialist.

* Prepare reports and summaries of credentialing activities for review by the Credentialing Manager or team.

* Assist in training new team members on credentialing processes and software.

Required Knowledge and Skills:

* Basic knowledge of credentialing processes and healthcare regulations.

* Strong organizational skills with exceptional attention to detail and accuracy.

* Proficiency in credentialing software and Microsoft Office Suite (Word, Excel, Outlook).

* Excellent verbal and written communication skills for interacting with internal and external departments.

* Ability to multitask and work collaboratively in a fast-paced environment.

Additional Requirements

* Education: College or equivalent required; an Associate’s degree in healthcare administration or a related field is preferred.

* Experience:

* At least 1-3 years of administrative experience, preferably in healthcare or credentialing.

* Familiarity with credentialing software and US payer processes is an advantage.

* Attributes: Proactive, team-oriented, and capable of handling sensitive information professionally.

Work Environment

* Office-based or remote, depending on organizational needs.

* May require flexibility during high-demand periods to meet deadlines.

Shift / Hours:

Monday Friday in one single shift, 9:00 AM EST - 6:00 PM EST. Note this is +12 or +13 Philippine time, which will be 9:00 PM PHT 6:00 AM in PHT.