Credentialing Specialist

This is a full time position, Monday-Thursday 8:00 am-6:30 pm.

POSITION SUMMARY

The Credentialing Specialist is responsible for assisting with the credentialing and privileging process for the provider staff; for preparing and processing enrollment applications for provider participation in health insurance (payor) plans; for assisting in the preparation of materials for Provider and Credentials meetings; and, for providing staff assistance to the Provider Staff Liaison on difficult/complex projects and programs pertaining to clinical operations. This position reports to the Provider Staff Liaison and has no supervisory responsibilities.

GENERAL RESPONSIBILITIES

Assists with the preparation and processing of initial and reappointment credentialing applications for clinical providers. Maintains credentialing files, ensuring all documentation is current, complete, and compliant with applicable standards. Tracks expiration dates for licenses, certifications, and other required credentials and notifies appropriate parties of upcoming renewals. Supports data entry and record maintenance within credentialing systems and files. Assists in preparing enrollment applications for provider participation in health insurance (payor) plans. Gathers required documentation and follows up on outstanding items for timely submission. Tracks application statuses and communicates updates to the Provider Staff Liaison. Assists with re-credentialing requests and documentation collection. Assists with coordinating provider PTO and CME requests, ensuring appropriate documentation and approvals are obtained. Supports the preparation of monthly provider schedules to help ensure adequate staffing coverage across all centers. Assists in tracking provider availability, call schedules, and coverage needs. Assists in maintaining credentialing and privileging records in accordance with AAAHC standards, Bureau of Primary Health Care policies, and state/federal regulations. Help prepare reports, spreadsheets, and supporting documentation for audits, surveys, and internal reviews. Provides administrative support for policy updates, forms, and process improvements as directed. Maintains confidentiality of all provider and organizational information. Provides administrative support on special projects related to provider staffing operations. Communicates professionally with providers, staff, and external entities as needed. Performs other duties as assigned.