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Credentialing Specialist
SagilityCredentialing Specialist responsible for provider credentialing within health plan operations. This role ensures compliance with internal standards and offers a high-quality provider experience.
About the role
Key responsibilities & impact- Verify provider credentials through approved sources in a timely and accurate manner
- Track and process credentialing and re-credentialing applications
- Enter and update provider information in the credentialing database
- Maintain and update provider demographics
- Monitor and manage data from delegated entities
- Communicate with providers or their office staff regarding credentialing status and required documentation
- Identify and report non-compliance or credentialing issues to the supervisor
- Ensure confidentiality of sensitive data and documents
- Perform other duties as assigned
Requirements
What you’ll need- 1+ years of experience of provider credentialing for a health plan
- Strong organizational and time management skills
- Ability to meet deadlines and handle high-volume work
- Able to work independently and in a team setting
- Strong attention to detail and problem-solving skills
- Familiarity with NCQA, CMS, and state credentialing standards
- Excellent written, verbal, and interpersonal communication skills.
Benefits
Comp & perks- Medical, Dental, and Vision coverage.
- Life Insurance.
- Short-Term and Long-Term Disability options.
- Flexible Spending Account (FSA).
- Employee Assistance Program.
- 401(k) with employer contribution.
- Paid Time Off (PTO).
- Tuition Reimbursement.
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 Database ManagementData EntryApplication ProcessingCompliance ReportingProvider Information Maintenance
Soft Skills
Time ManagementProblem-SolvingInterpersonal CommunicationWritten CommunicationTeam Collaboration