Credentialing & Licensure Specialist

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Job description

Role and Responsibilities

The Credentialing & Licensure Specialist is responsible for maintaining active status for all providers by successfully completing initial and subsequent credentialing packages as required by hospitals, surgery centers, and commercial payers.

Roles and Responsibilities

• Maintains compliance with all regulatory and accrediting institutions.
• Manages individual provider files to include up to date information needed to complete the required governmental and commercial payer credentialing applications.
• Maintains CE hours to ensure compliance with state regulations.
• Applies for and renews all provider licenses.
• Completes revalidation requests issued by government payers.
• Completes credentialing applications to add providers to commercial payers and re-credentialing applications for commercial payers.
• Partners with Clear Choice to ensure credentialing of new providers and re-credentialing current providers.
• Maintains provider credentials with hospitals at which they hold staff privileges.
• Facilitates Integration of Acquisition and required processes.
• Works closely with the Revenue Cycle team to identify and resolve any denials or authorization issues related to provider credentialing.
• Performs other duties as assigned.

Education and Experience

• High School Diploma or equivalent required.
• Associates degree in related field preferred.
• Two or more years of relevant experience required.
• Credentialing experience preferred.

Skills and Abilities

• Knowledge of provider credentialing.
• Excellent computer skills including Excel, Word, and Internet use.
• Detail oriented with above average organizational skills.
• Excellent customer service skills.
• Excellent written and verbal communication skills.
• Ability to plan, prioritize, and meet deadlines.

Core Benefits & Wellness

Medical (including Virtual Care), Dental, and Vision Coverage

Employee Assistance Program (EAP)

Financial Well-Being

Competitive pay, Bonus potential, and annual merit reviews

401(k) Plan w/Company Match

Health Savings Account (HSA) with HDHP health plans

Life Insurance

Basic and Supplemental Life Insurance

Spouse and Child Life Insurance

Time Off, Disability And Leave Of Absence

Paid Vacation (Starting at 2 weeks) and 6 Annual Paid Holidays

Long and Short Term Disability Plans

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