Credentialing Specialist

Job Description

Job Summary 

The Credentialing Specialist, under the direction of the Operational Support Services Leadership, maintains administrative rights to all insurance websites so that access requests can be fulfilled for SSC, Hospital, Corporate, and Contracted Vendor associates; request resolution must be completed timely and with outstanding customer service. The position accomplishes this while ensuring Internal Audit Guidelines are being met, guided by Operational Support Leadership and the objectives of the SSC.. 

Essential Functions

• Collects, verifies, and processes healthcare provider credentials to ensure compliance with regulatory and accreditation standards.
• Maintains accurate, up-to-date provider files in the credentialing database, tracking changes and expiration dates.
• Serve as a liaison between providers, insurance companies, and regulatory bodies, informing them of credentialing status and required updates.
• Supports the enrollment of providers with insurance carriers and government programs, ensuring correct setup in networks.
• Prepares and maintains reports on credentialing status and assist with audits and accreditation surveys.
• Identifies opportunities to improve credentialing workflows and participate in professional development.
• Performs other duties as assigned.
• Complies with all policies and standards.

Qualifications

• H.S. Diploma or GED required
• Associate Degree in healthcare administration, business, or a related field preferred
• 1-2 years experience in healthcare revenue cycle or business office. required
• 2-4 years experience in healthcare revenue cycle or business office. preferred

Knowledge, Skills and Abilities

• Strong understanding of healthcare credentialing processes, accreditation standards, and regulatory requirements.
• Excellent attention to detail and organizational skills.
• Strong communication skills (verbal and written), with the ability to interact with healthcare providers, insurance companies, and regulatory agencies.
• Ability to manage multiple tasks and meet deadlines in a fast-paced environment.
• Problem-solving and critical thinking skills.