Provider Enrollment & Credentialing Specialist

Credentialing Specialist Key Result Areas:

• Enrolling providers with payors federally, both in state and out of state
• Understand and utilize best practice by abiding by individual payor standards.
• Monitor provider enrollment and revalidations based on due dates to avoid any interruptions in reimbursement.
• Participate in the development of internal credentialing processes and procedures.
• Monitor provider credentials, licenses, certifications, and memberships to ensure records are current and consistent with regulations and policies.
• Maintain reports and database of credentialing activities such as accreditation, memberships, licensure, or facility privileges

Core Competencies:

• Teamwork
• Communication
• Work standards
• Organizing
• Reliability
• Adaptability
• Detailed
• Results Orientated

Education and Experience:

• High school diploma or GED equivalent, is required
• Associate’s or bachelor’s degree preferred.
• Must have previous payor enrollment experience
• 5 years’ experience in provider enrollment and credentialing
• CMSC (Certified Medical Staff Coordinator) or CPCS (Certified Provider Credentialing Specialist) is a plus
• Knowledge of medical terminology required

For a more detailed description of job, please see attached job description.