Senior Credentialing Specialist

Senior Credentialing Specialist Overview

• The Senior Credentialing Specialist will oversee credentialing and recredentialing processes for non-delegated providers, vendors, and facilities, ensuring compliance with industry regulations.
• Collaborate with internal teams and external contacts to obtain necessary documentation and resolve credentialing issues efficiently.
• Prepare and present credentialing summaries to the Credentialing Committee, ensuring thorough and accurate documentation.
• Participate in meetings to address inquiries and establish credentialing requirements for stakeholders.
• Support the development and maintenance of internal systems for tracking and monitoring credentialing processes.
• Develop job aids, workflows, and policies to enhance credentialing procedures and systems.
• Ensure compliance with NYS and CMS credentialing regulations and organizational policies.
• Work in a collaborative and dynamic environment, contributing to the organization's operational excellence.

Senior Credentialing Specialist Key Responsibilities & Duties

• Perform primary source verifications and query relevant databases such as CAQH, NPDB, and ABMS.
• Troubleshoot credentialing issues and liaise with internal and external contacts to resolve them.
• Audit and prepare flagged files for presentation to the Credentialing Committee.
• Develop and maintain credentialing workflows, job aids, and policies to streamline processes.
• Participate in internal and external meetings to address credentialing inquiries and define requirements.
• Prepare and review bi-weekly clean file approval lists for medical directors.
• Support the development of internal provider systems for credentialing tracking and monitoring.
• Ensure compliance with all relevant credentialing regulations and organizational standards.

Senior Credentialing Specialist Job Requirements

• High School Diploma or GED is required; a Bachelor's degree is preferred.
• Minimum of 3 years of credentialing experience, with 5 years preferred.
• Proficiency in MS Word, Excel, and Outlook; familiarity with PowerPoint and OneNote is a plus.
• Strong organizational, follow-up, and attention-to-detail skills are essential.
• Experience in file auditing and developing credentialing workflows and policies is advantageous.
• Excellent verbal and written communication skills to effectively liaise with stakeholders.
• Ability to troubleshoot and resolve conflicts, escalating issues when necessary.
• Capability to train others on credentialing and recredentialing requirements.