Senior Credentialing Specialist

The Credentialing Assistant provides administrative and operational support to the Credentialing and Provider Enrollment team for Resolv Hospital clients. This role is responsible for maintaining accurate provider records, managing credentialing documentation, coordinating enrollment processes, and ensuring compliance with HIPAA regulations.

The ideal candidate is detail-oriented, organized, and comfortable working with credentialing software, Excel tracking sheets, and external health plan representatives.

Key Responsibilities

Provider Enrollment & Credentialing Support

• Assist in completing and submitting provider enrollment applications
• Track outstanding applications and follow up with health plans and provider relations representatives to ensure timely enrollment completion
• Support new practice setup as needed
• Submit change-of-information letters and W-9 forms for practice updates (e.g., new locations, address changes, remit updates)

Provider Records & Documentation Management

• Create and maintain electronic credential files according to Global Share Filing Structure Policy
• Maintain and update provider data sheets and credential spreadsheets
• Ensure provider records in credentialing software databases remain accurate and up to date
• Maintain organized and current electronic credential files
• Set reminders in Verity CredentialStream for credential expiration dates
• Update documentation such as medical licenses, DEA registrations, COIs, and other required credentials

CAQH & Compliance Management

• Maintain CAQH re-attestation tracking and complete required re-attestations
• Ensure all credentialing activities comply with HIPAA guidelines and safeguard protected health information (PHI)

Communication & Follow-Up

• Respond to incoming emails and faxes regarding credential renewals, W-9 requests, and related inquiries
• Contact health plans and medical facilities to check the status of applications, contracts, or change requests
• Provide updates and documentation to internal stakeholders as needed

Systems & Reporting

• Document all daily activities in Verity CredentialStream, SharePoint, Teamwork, and Time Tracker
• Maintain Excel tracking sheets for emergency and urgent care practices
• Provide research and administrative support for special projects

Qualifications

• At least 1 year experience in credentialing, provider enrollment, or healthcare administration preferred
• Strong attention to detail and organizational skills
• Proficiency in Microsoft Excel and document management systems
• Familiarity with credentialing software (e.g., Verity CredentialStream) is a plus
• Excellent written and verbal communication skills
• Ability to manage multiple tasks and follow up consistently

Why Join Us

• Work with established healthcare clients
• Be part of a collaborative credentialing team
• Gain hands-on experience in provider enrollment and compliance processes
• Opportunity for professional growth in healthcare administration