Credentialing Specialist

Purpose - The Junior to Mid Credentialing Specialist supports the accurate and timely credentialing and recredentialing of healthcare providers with insurance networks, clearinghouses, and other credentialing bodies. This role involves assisting the Senior Credentialing Specialist in maintaining compliance, ensuring accurate documentation, and coordinating with insurance networks and other credentialing entities.

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.

Key Qualifications:

• 1-3 years of experience (Junior or early Mid)

• Experience with Advanced MD required

• 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.

• Good English speaker and phone voice

• Reliable, and willing to work “night shift” in Philippines

Shift / Hours:

Monday Thursday from 7:00 AM MST 4:00 PM MST, and Friday 7:00 AM MST 12:00 PM MST. This is for 8 hours over a 9-hour shift which is 9:00 PM PHT 6:00 AM in PHT from Monday to Thursday, and 9:00 PM PHT 2:00 AM PHT on Friday. Note this is +14 hours, Philippine Time. Once the billers are fully trained, client is flexible in allowing talents to work a different shift (e.g. day shift in the Philippines)