credentialing specialist

AP Health

<div>Location: Nashville, TN
Employment Type: Full-Time, M-F Hybrid role
AP Health is a fast-growing healthcare services company located in Nashville, TN. We provide clinical staff and services to hospitals, surgeons, and surgery centers. Our corporate office in Green Hills is seeking an Onboarding Specialist to join our team. Our company values innovation, collaboration, and growth. We look forward to finding the right person to join our growing team!
What you will do:
<ul><li>Work with providers to complete applications for hospital and surgical facility privileges</li>
<li>Monitors all provider reappointment deadlines and completes all necessary reappointment packages</li>
<li>Provide instruction and updates to providers on onboarding and credentialing processes</li>
<li>Serve as a point person between AP Health and facility staff members</li>
<li>Maintain up-to-date data for each provider in credentialing databases, online systems, LogistiSx, and ADP</li>
</ul>
What you need:
<ul><li>At least one year of credentialing or healthcare onboarding experience</li>
<li>Ability to stay organized and prioritize work load</li>
<li>Clear and concise communication skills</li>
<li>College degree required (AS included)</li>
</ul>
Benefits:
<ul><li>Hybrid, flexible work schedule</li>
<li>Medical, dental and vision insurance for all healthcare services</li>
<li>Paid Time Off</li>
<li>Health Savings Account with company match on your contributions</li>
<li>Short and long-term disability, basic and supplemental life insurance</li>
<li>401K retirement plan with company match on your contributions</li>
<li>Participation in the company&rsquo;s Employee Stock Option Plan (ESOP)</li>
</ul>
Excellence at Work: AP Health is a certified Great Place to Work&trade;- a national designation based on employee feedback about trust, workplace culture, and experience.</div>

Credentialing Specialist

Rogers Behavioral Health

<div>The Credentialing Specialist is primarily responsible for activities impacting facility and practitioner external provider enrollment and credentialing; this includes all network application and maintenance processes that impact facilities and applicable practitioners employed or contracted by Rogers Memorial Hospital, Inc.
 
 
In all activities, the Credentialing Specialist must remain aware of and comply with legal, regulatory, and financial policies and procedures. The Credentialing Specialist is in regular contact with payer strategies, medical office staff, financial services, physicians/ practitioners, and contracted payer staff. The Credentialing Specialist is responsible for maintaining up-to-date file information on payer enrolled practitioners in multiple systems, answering inquiries regarding a provider&rsquo;s network status, and collaborating with colleagues to ensure the accuracy of facility contracted networks and affiliations. 
 
The candidate must live in one the following states: WI, CA, GA, FL, MN, IL, CO, PA, TN, or WA<h2 class="jobSectionHeader">
Job Duties &amp; Responsibilities:</h2>
Provider Enrollment Application Processing<ul><li>
Maintain understanding of RBH Privacy Practices, HIPAA, Medical Staff standards, state and federal= requirements, and other applicable corporate and departmental policies.</li><li>
Responsible for facility and practitioner enrollment activities, maintaining up to date file information in multiple systems, answering inquiries related to network status, collaborating with colleagues to ensure accuracy of facility contracted networks and affiliations</li><li>
Recommend policy and procedural updates as applicable</li><li>
Maintain standard outreach to on-boarding medical staff providers detailing initial and ongoing provider= enrollment requirements</li><li>
Maintain knowledge of all data and document locations required as part of the enrollment process</li><li>
Maintain knowledge of standard work detailing contracted payer provider credentialing processes for all exclusive contracts.</li><li>
Communicate accurate RBH location and demographic information</li><li>
Populate and maintain both facility and provider level information in the CAQH system</li><li>
Enroll and maintain facilities and practitioners in all appropriate contracted health plans</li><li>
Enroll practitioners with government payers using electronic application methods such as PECOS and portals</li><li>
Populate credentialing software with timely and accurate provider status and affiliation information</li><li>
Monitor and disseminate affiliation, application and revalidation status upon request and as applicable</li><li>
Maintain privacy and confidentiality at all times.</li></ul>
Payer Strategies_ Internal<ul><li>
Establish and maintain positive and cooperative working relationship with Payer Strategies team</li><li>
Remain aware of contractual adjustments that may impact provider affiliations and/or payment</li></ul>
Patient Financial Services _ Internal<ul><li>
Establish and maintain positive and cooperative working relationship with all Patient Financial Services team= professionals</li><li>
Populate and maintain Symplr Provider information referenced by PFS staff to investigate and appeal= professional claim denials</li><li>
Establish and provide ongoing assist with PFS staff Symplr Provider logins</li></ul>
Contracted Payer Groups _ External<ul><li>
Regular written and verbal communications with payer group representatives at multiple levels</li><li>
Respond to all applicable payer outreach for information and/or clarification</li></ul>
Other Duties and Responsibilities<ul><li>
Complete projects as assigned by Credentialing Manager</li><li>
Regular assistance with and dissemination of payer communications impacting other departments</li><li>
Participate in process improvement events and activities</li><li>
Serve as a back-up to other Payer Strategies positions on an as-needed basis.</li><li>
Assist in promoting a team atmosphere by treating individuals with respect and honesty and by using direct= communication and active listening skills.</li></ul>
Additional Job Description:<div><h2 class="jobSectionHeader">
Qualifications / Required:</h2></div><ul><li>
Associate&rsquo;s degree or 2 years' experience</li><li>
Administrative skills, including computer/word processing</li><li>
Computer proficiency, adaptability and working knowledge of Microsoft Office, Adobe and Excel</li><li>
Exceptional critical thinking skills and sound judgement</li><li>
Exceptional written, verbal, and auditory skillset</li><li>
Ability to perform all essential job functions either on site or remotely</li></ul><h2 class="jobSectionHeader">
Qualifications / Preferred:</h2><ul><li>
Working knowledge of credentialing accreditation regulations, policies and procedures, and NCQA standards</li><li>
General understanding of health insurance plans, provider enrollment processes, payer contracting and remittance processes, and HIPAA and healthcare compliance</li><li>
Familiarity with practitioner billing and claims payment system requirements as related to practitioner enrollment</li><li>
Symplr Experience</li><li>
Experience with CAQH (Council for Affordable Quality Healthcare) database and application process</li><li>
Prior professional history in a medical or mental health setting</li><li>
NAMSS/CPCS Certification</li></ul>
With a career at Rogers, you can look forward to a Total Rewards package of benefits, including:<ul><li>
Health, dental, and vision insurance coverage for you and your family</li><li>
401(k) retirement plan</li><li>
Employee share program</li><li>
Life/disability insurance</li><li>
Flex spending accounts</li><li>
Tuition reimbursement</li><li>
Health and wellness program</li><li>
Employee assistance program (EAP)</li></ul>
Through UnitedHealthcare, UMR and HealthSCOPE Benefits creates and publishes the Machine-Readable Files on behalf of Rogers Behavioral Health. To link to the Machine-Readable Files, please visit Transparency in Coverage (uhc.com)</div>

Therapy Alliance of Michigan

Overview We are seeking a detail-oriented and proactive Billing and Credentialing Specialist to join our dynamic healthcare team. In this vital role, you will ensure accurate billing processes, manage provider credentialing, and maintain compliance with industry standards. Your expertise will directly contribute to the seamless operation of our healthcare services, supporting both administrative efficiency and high-quality patient care. This position offers an exciting opportunity to work in a fast-paced environment where your skills in managed care, medical terminology, and compliance standards will make a meaningful impact.Responsibilities<ul><li>Manage the complete billing cycle, including claim submission, follow-up, and resolution of denials to optimize revenue flow.</li><li>Verify insurance coverage and benefits through managed care plans to ensure accurate billing and reimbursement.</li><li>Maintain up-to-date provider credentials by coordinating with insurance companies and credentialing organizations in accordance with NCQA (National Committee for Quality Assurance) standards.</li><li>Review medical documentation for accuracy and completeness, ensuring compliance with healthcare regulations and industry best practices.</li><li>Collaborate with medical offices to gather necessary documentation and resolve credentialing issues promptly.</li><li>Stay informed about changes in managed care policies, healthcare regulations, and NCQA standards to ensure ongoing compliance.</li><li>Prepare detailed reports on billing activities, credentialing status, and compliance metrics for management review.</li></ul>Experience<ul><li>Proven experience in medical billing, coding, or related administrative roles within a healthcare setting.</li><li>Strong understanding of managed care processes and insurance claim procedures.</li><li>Prior medical office experience is highly preferred, demonstrating familiarity with healthcare workflows.</li><li>Knowledge of medical terminology is essential for accurate documentation review and communication.</li><li>Experience working in environments that adhere to NCQA standards or similar accreditation requirements is a plus.</li><li>Excellent organizational skills with the ability to manage multiple priorities efficiently.</li><li>Strong communication skills to collaborate effectively with providers, insurance companies, and internal teams. Join us as a Billing and Credentialing Specialist and be part of a dedicated team committed to delivering exceptional healthcare services through precision, compliance, and compassionate support!</li></ul>Pay: $21.00 - $24.00 per hourBenefits:<ul><li>401(k)</li><li>401(k) matching</li><li>Flexible schedule</li><li>Paid time off</li></ul>Work Location: Hybrid remote in Warren, MI 48093

Billing and Credentialing Specialist

Hamilton Health Care System

<div>Hours: 8AM - 4:30PM, Weekdays<div><div>
JOB SUMMARY</div></div><div><div>
Serves as a liaison for Medical Staff members, their office personnel and Administration. Assists the Credentialing Coordinators with clerical and administrative duties including planning and organizing functions of Medical Staff Services and preparation of correspondence and memorandums. Assists in receiving and processing all initial and reappointments for Medical Staff, Allied Health Professional, and Physician Personal Employee applications. Communicates regularly with all applicants regarding information needed for completion of applications. Completes queries needed for credentialing applications including personal and professional references, hospital affiliations, education, required data banks, and primary source verification. Enters, updates, and maintains data in the credentialing database. Monitors files for accuracy, completeness, and compliance with regulatory requirements and the Medical Staff Bylaws and Credentialing policies. Assists with completion and distribution ED call schedule. Responds to affiliation queries received from other hospitals.</div></div>
JOB QUALIFICATIONS
Education: Two years of college level courses, preferably in secretarial science or office administration, associates degree preferred
Licensure: None
Certification: NAMSS Certified Provider Credentialing Specialist (CPCS) desired
Experience: Two years&rsquo; secretarial experience in hospital or related health area
Skills: Proficient in typing, transcription and use of word processing software as well as Credentialing Software. Additional computer experience preferred. Use of other office equipment a must. Knowledge of medical terminology necessary. Job requires initiative, organizational ability, excellent communication and interpersonal skills. Must be self-motivated and detail-oriented.
PHYSICAL, MENTAL, ENVIRONMENTAL AND WORKING CONDITIONS
Typical office environment subject to constant interruptions and heavy work volume requirements. Moderate amounts of physical activity, including stooping, loading, lifting. Ability to handle high stress level and work under pressure. Must be able to maintain confidentiality.
Full-Time Benefits<ul><li>
403(b) Matching (Retirement)</li><li>
Dental insurance</li><li>
Employee assistance program (EAP)</li><li>
Employee wellness program</li><li>
Employer paid Life and AD&amp;D insurance</li><li>
Employer paid Short and Long-Term Disability</li><li>
Flexible Spending Accounts</li><li>
ICHRA for health insurance</li><li>
Paid Annual Leave (Time off)</li><li>
Vision insurance</li></ul></div>

Credentialing Specialist - FT - Days

Psychiatry of Texas

About the Role We are seeking a Hospital Credentialing Specialist to oversee and coordinate the full credentialing and privileging lifecycle for medical staff and allied health professionals. This role is essential in ensuring all providers meet hospital standards for qualifications, experience, and regulatory compliance while supporting safe, high-quality patient care.Key ResponsibilitiesCredentialing &amp; Compliance<ul><li>Manage end-to-end credentialing and recredentialing for all hospital-based providers</li><li>Ensure adherence to hospital bylaws, accreditation standards, and regulatory requirements</li><li>Monitor and track expiration dates to maintain continuous provider compliance</li></ul>Application &amp; Verification Management<ul><li>Collect, review, and verify all required provider documentation, including:</li><li>Personal data, education, training, and employment history</li><li>Licensure, DEA, and board certifications</li><li>Malpractice coverage and claims history</li><li>Case logs, immunizations, and peer references</li><li>Ensure applications are accurate, complete, and submitted in a timely manner</li></ul>Background Checks &amp; Privileging<ul><li>Coordinate criminal background checks and primary source verifications</li><li>Partner with medical leadership to evaluate qualifications and assign privileges</li><li>Prepare files and summaries for medical staff committees and approval bodies</li></ul>Records &amp; Documentation<ul><li>Maintain secure, accurate, and confidential provider files</li><li>Organize verifications, approval letters, committee minutes, and correspondence</li><li>Ensure all records meet Joint Commission, NCQA, and regulatory standards</li></ul>Approval &amp; Onboarding Support<ul><li>Notify providers upon approval and distribute onboarding materials, including:</li><li>Medical record and documentation guidelines</li><li>Safety protocols and hospital policies</li><li>Orientation schedules and medical staff meeting information</li></ul>Ongoing Monitoring &amp; Audits<ul><li>Proactively manage reappointment cycles and expiring credentials</li><li>Prepare credentialing files for audits, surveys, and inspections</li><li>Maintain current data in credentialing systems and internal databases</li></ul>Qualifications<ul><li>1&ndash;3 years of experience in hospital credentialing (preferred)</li><li>Working knowledge of hospital accreditation and regulatory standards</li><li>Experience with credentialing databases and systems</li><li>Exceptional organizational skills and attention to detail</li><li>Strong written and verbal communication skills</li><li>Proven ability to handle confidential information with discretion</li></ul>Job Type: Full-timePay: Rs120,000.00 - Rs140,000.00 per monthApplication Question(s):<ul><li>How many years of experience do you have with credentialing?</li><li>Rate your English communication skills from 1 to 10.</li><li>What are your salary expectations?</li><li>How soon can you join us?</li></ul>Work Location: In person

Hospital Credentialing Specialist - Experience Required

The Garden of Eve

Job Title:Credentialing SpecialistWho We Are7 KINGS CODE is US based Software solutions company. We support our partners and clients globally in USA, CANADA, EUROPE, INDIA, PAKISTAN &amp; MIDDLE EAST.Education &amp; Experience Required:<ul><li>Bachelor&rsquo;s degree in healthcare administration, business, or a related field preferred. Equivalent experience may be considered.</li><li>4+ years of experience in credentialing, enrolment, or related roles in the medical billing industry.</li></ul>Skills Required:<ul><li>Solid experience in credentialing of Clinics and Labs</li><li>Familiarity with Medicare, Medicaid, and commercial payer enrolment processes.</li><li>Proficiency in credentialing software and tools (e.g., CAQH ProView, PECOS).</li><li>Strong knowledge of medical billing processes and insurance verification.</li><li>Familiarity with HIPAA and other healthcare regulations.</li></ul>Job Location: Onsite, DHA Phase 8 - Ex Park View, Lahore.Job Timings: PAK TIME: 5:30PM to 02:30AMApply with your latest cv at: hr@7kingscode.comJob Type: Full-timeAbility to commute/relocate:<ul><li>Lahore: Reliably commute or planning to relocate before starting work (Required)</li></ul>Education:<ul><li>Bachelor's (Required)</li></ul>Experience:<ul><li>Credentialing of Clinics and Labs: 4 years (Required)</li></ul>Work Location: In personJob Type: Full-timePay: Rs100,000.00 - Rs150,000.00 per monthWork Location: In person

Credentialing & Enrollment specialist

MTBC CareCloud

Role OverviewThe Credentialing Analyst will be responsible for supporting and managing provider and facility credentialing processes with commercial insurance companies and government payers. This role is ideal for early-career professionals who can work independently, collaborate with cross-functional teams, and ensure compliance with payer requirements.Key Responsibilities<ul><li>Assist in end-to-end credentialing and re-credentialing of healthcare providers and facilities</li><li>Prepare, submit, and track credentialing applications with commercial insurers and government payers</li><li>Maintain accurate and up-to-date provider records and credentialing databases</li><li>Follow up with payers to ensure timely approvals and resolve credentialing issues</li><li>Coordinate with internal teams such as billing, operations, and client services</li><li>Ensure compliance with payer guidelines and internal policies</li></ul>Required SkillsTechnical Skills<ul><li>Proficiency in Microsoft Office Suite (Word, Excel, Outlook)</li></ul>Soft Skills &amp; Personal Attributes<ul><li>Strong written and verbal communication skills</li><li>Good interpersonal and coordination abilities</li><li>Strong problem-solving mindset</li><li>Ability to work independently and as part of a team</li><li>Well-disciplined with effective time-management skills</li><li>Ability to handle pressure and meet deadlines</li><li>Quick learner with a positive attitude</li></ul>Language Requirements<ul><li>English (Written and Spoken)</li></ul>Educational Qualification<ul><li>Bachelor&rsquo;s degree (required)</li></ul>Job Type: Full-timePay: Rs50,000.00 - Rs70,000.00 per monthAbility to commute/relocate:<ul><li>Islamabad: Reliably commute or planning to relocate before starting work (Preferred)</li></ul>Application Question(s):<ul><li>What is your current salary? (In PKR)</li><li>What is your expected salary? (In PKR)</li><li>How early can you join us? (In PKR)</li></ul>Work Location: In person

Credentialing Analyst

Search 5234+ Credentialing specialist jobs near you this March. New roles added regularly across leading industries. Apply today.

5234 credentialing specialist jobs Near Me

Credentialing Specialist

Credentialing Specialist

Billing and Credentialing Specialist

Credentialing Specialist - FT - Days

Hospital Credentialing Specialist - Experience Required

Credentialing & Enrollment specialist

Credentialing Analyst