Provider Credentialing Specialist

Job Summary

A company is looking for a Provider Credentialing Specialist I (Remote).

Key Responsibilities

• Analyze credentialing applications and perform primary source verification of credentials for practitioner network participation
• Respond to inquiries regarding provider participation eligibility, status, and updates while ensuring a positive provider experience
• Maintain provider files and data management systems, ensuring accuracy and compliance with applicable laws and guidelines

Required Qualifications

• High School Diploma or GED
• 3 years of experience in physician credentialing or health insurance/managed care operations
• Proficiency in Excel, including understanding of Pivot tables
• Knowledge of medical terminology
• Ability to understand jurisdictional requirements and legal ramifications of credentialing processes