Job Description

Job Description

Job Description

Job Title: Payor Credentialing Specialist

Job Summary:
We are seeking a detail-oriented and highly organized Payor Credentialing Specialist to join our healthcare team. In this role, you will be responsible for managing the credentialing and recredentialing processes for healthcare providers and our professional company with insurance payors, government programs, and other third-party entities. Experience in mental health credentialing is highly desirable. Your expertise will ensure compliance with regulatory requirements, maintain accurate provider records, and support the efficient delivery of patient care.

Key Responsibilities:

• Credentialing and Recredentialing:
  • Complete and submit credentialing applications for providers with various insurance payors, Medicare/Medicaid, and other third-party entities.
  • Manage recredentialing processes to maintain active provider status with all payors.
  • Monitor deadlines and ensure timely submission of all documentation.
• Documentation Management:
  • Gather and verify required documents, including licenses, certifications, malpractice insurance, education, and employment history.
  • Maintain up-to-date and accurate provider records in internal and external credentialing databases.
• Compliance and Quality Assurance:
  • Ensure compliance with federal, state, and payor-specific regulations and requirements.
  • Conduct ongoing audits to ensure accuracy and completeness of credentialing records.
• Communication and Coordination:
  • Act as the primary point of contact between providers, payors, and internal departments for credentialing matters.
  • Resolve discrepancies or issues related to credentialing in a timely and professional manner.
  • Educate and guide providers and staff on credentialing processes and requirements.
• Reporting and Tracking:
  • Prepare regular status reports on credentialing activities for management.
  • Utilize credentialing software to track application progress and monitor renewal deadlines.

Qualifications:

• Education:
  • High school diploma or equivalent required; associate or bachelor’s degree in healthcare administration or a related field preferred.
• Experience:
  • Minimum of 2 years of experience in healthcare credentialing or a related field.
  • Experience with mental health credentialing is a strong plus.
• Skills and Competencies:
  • Knowledge of credentialing processes, insurance payor requirements, and compliance standards.
  • Familiarity with credentialing software and databases.
  • Exceptional organizational skills with attention to detail and accuracy.
  • Strong written and verbal communication skills.
  • Ability to prioritize tasks and meet strict deadlines.
  • Proficiency in Microsoft Office Suite (Word, Excel, Outlook).

Preferred Qualifications:

• Experience with CAQH, PECOS, and payer-specific portals.
• Knowledge of state and federal regulations related to credentialing.
• Familiarity with mental health practices and providers.

Work Environment:
This role is primarily office-based, with potential for remote work depending on organizational policies. The position requires collaboration with providers, payors, and administrative staff in a fast-paced and deadline-driven environment.

Why Join Us?

• Contribute to the smooth operation of a healthcare organization that makes a difference in patients’ lives.
• Be part of a supportive and dynamic team.
• Gain valuable experience in the evolving field of healthcare credentialing.

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