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Credentialing Specialist
Aria Care PartnersCredentialing Specialist role managing healthcare provider applications for health insurance networks. Responsible for organization, compliance, and communication with payers and internal teams.
About the role
Key responsibilities & impact- The Credentialing Specialist will be responsible for timely submission and follow-up for institutional and individual provider credentialing, contracting, and re-credentialing with health insurance payors across multiple states and service lines.
- Assists in verifying and monitoring credentials of healthcare providers and completing facility applications as needed.
- Maintains confidential files of providers records to meet company and compliance standards.
- Prepare and submit credentialing applications and supporting documentation for the purpose of enrolling groups and providers with Commercial, Medicare, and Medicaid networks.
- Follow up on the status of applications for providers with payers, tracking progression of pending and completed work.
- Maintains accurate and up-to-date database of information including provider credentials and payer statuses.
- Works closely with internal teams to communicate approvals and work through denials as necessary.
- Maintains knowledge of current payer requirements across multiple states and service lines.
- Maintain strict level of confidentiality and HIPAA compliance.
- Familiarity with state licensing requirements and provider onboarding tasks.
- Familiarity with various payer portals and CAQH.
- Contact providers and payers, by phone or email, for updates and/or to request missing information.
- Ensure group and provider information is current/accurate with health insurance payers.
- Assist with facility credentialing applications as needed.
Requirements
What you’ll need- Minimum two years of health insurance credentialing experience preferred.
- Prior data management/data integrity experience preferred.
- Associates degree preferred.
- Proficient with Microsoft Office, including Excel, Word, and Outlook
- Excellent organization and communication skills.
- Quick thinking, positive, and professional, with demonstrated problem solving, attention to detail, and critical thinking skills.
- Ability to work independently, set priorities, and meet deadlines.
- Adapt to changes in work environment, manage competing demands and deal with frequent change, delays, or unexpected events.
- Able to work in a team environment.
Benefits
Comp & perks- PTO and Paid Holidays for FT Employees
- 401k Retirement Plan with Company Match
- Insurance programs including medical, dental, vision, company match for your HSA, FSA, company-paid EAP, and life and disability insurance, and more.
ATS Keywords
✓ Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
Credentialing ApplicationsProvider VerificationData IntegrityFacility ApplicationsPayer Portals FamiliarityCAQH FamiliarityApplication TrackingProvider Records ManagementContractingRe-Credentialing
Soft Skills
Excellent OrganizationCommunication SkillsProblem SolvingAttention to DetailAdaptability
Certifications
Associates Degree