Healthcare Credentialing Specialist

6 days ago


Mansfield, Ohio, United States Third Street Family Health Service Full time

**Job Summary**

We are seeking a highly motivated and detail-oriented Healthcare Credentialing Specialist to join our team at Third Street Family Health Service. As a crucial member of our healthcare team, you will provide administrative support in credentialing, privileging, and payer enrollment processes.

**Key Responsibilities:**

  • Collect, review, and organize credentialing applications and supporting documentation.
  • Verify licensure, certifications, and other credentials as directed by the Credentialing Specialist.
  • Maintain accurate and up-to-date credentialing files.
  • Monitor expiration dates for licenses, certifications, and contracts, ensuring timely renewals.
  • Prepare and submit credentialing applications and reports.
  • Assist in internal and external audits by organizing credentialing records and responding to document requests.

**Payer Enrollment Assistance:**

  • Aid in completing and tracking enrollment applications with Medicare, Medicaid, and private insurance payers.
  • Follow up with payers regarding enrollment status and provide updates to the Credentialing Specialist.
  • Maintain updated records of payer contracts and fee schedules.
  • Track contract expiration and renewal deadlines to ensure timely submission.

**Compliance & Communication:

  • Evaluate compliance with relevant regulations and accreditation standards.
  • Respond to credentialing and enrollment inquiries from providers and staff.
  • Collaborate with internal teams to ensure accurate and timely processing of credentialing information.
  • Communicate with external agencies, including insurance companies and regulatory bodies.


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