Credentialing Specialist

Overview

• Manage credentialing processes, vendor relationships, and compliance within a healthcare organization.
• Oversee delegated vendor audits and ensure adherence to credentialing standards.
• Coordinate credentialing committee preparations, including agendas, summaries, and reporting.
• Monitor provider networks for compliance and update internal trackers.
• Collaborate with internal stakeholders to resolve data issues and ensure accurate reporting.
• Prepare quarterly presentations and updates for compliance committees.
• Assist with special projects and contribute to continuous process improvement.
• Work remotely with flexible scheduling within approved states.

Key Responsibilities & Duties

• Review incoming credentialing cases and update case notes accordingly.
• Communicate issues and provide feedback to credentialing verification organizations.
• Log and track support tickets related to credentialing platforms.
• Coordinate Medical Director approvals for providers and update statuses.
• Identify and import provider network changes into credentialing systems.
• Monitor network compliance and report actions or sanctions.
• Prepare and present credentialing updates for compliance committees.
• Assist with annual audits of delegated vendors and special projects.

Job Requirements

• Minimum 5 years of experience in healthcare vendor management and credentialing.
• Preferred 7 years of experience in credentialing and vendor management roles.
• Associate's degree or equivalent education required; Bachelor's degree preferred.
• Proficiency in MS Office Suite, DocuSign, and SharePoint.
• Strong collaborative skills and ability to work in complex environments.
• Detail-oriented with excellent problem-solving and organizational abilities.
• Experience in healthcare industry settings such as managed care or insurance plans.
• Ability to work remotely within approved states and time zones.