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Credentialing Specialist



Reporting to the Fiscal and Data Services Specialist, the full-time exempt Credentialing Specialist is responsible for collecting, maintaining and preparing documentation that ensures providers are properly trained, licensed and certified as mandated by state and federal regulations.


  1. Responsible for credentialing and privileging of all medical providers, dentists, and other licensed and certified staff.
  2. Coordinates medical and dental plan enrollments and hospital privileges.
  3. Ensures timely medical and dental plan revalidations for providers, dentists, and Grace Health.
  4. Responsible for provider and dentist license applications and renewals.
  5. Query’s and monitors National Provider Databank for applicable staff.
  6. Serves as Point of Contact for National Health Service Corps loan repayment program, runs time and attendance reports and ensures timely submission of applications.
  7. Processes and tracks Worker’s Compensation claims.
  8. Maintains OSHA recordkeeping forms.
  9. Maintains general knowledge of industry trends and employment legislation and ensures compliance.
  10. Manages internal users of outside electronic health records systems.
  11. Consistently reviews the Credentialing and Privileging Policy and Procedure and makes changes to comply with HRSA requirements and internal processes.
  12. Roster providers in CAQH, and other plan required sites, including initial and ongoing maintenance (re-attestations, tracking and updating expiring credentials);
  1. Review and ensure credentialing and privileging files are completed and accurate, working directly with human resources and providers.
  2. Compile privileging binders for review/approval.
  3. Ensure Honor Community Health facilities and providers are credentialed, and re-credentialed properly with Medicare, Medicaid, and commercial plans according to each payors individual requirements and addresses/corrects discrepancies as requested by payors and Revenue Cycle Manager;
  4. Conduct all follow-up steps until payor approval/completion is obtained;
  5. Address enrollment disconnects in regards to facilities and providers;
  6. Prepare customized reports showing provide par status and application progress, facility and provider plan effective and term dates, and plan assigned ID number(s)
  7. Build a relationship with plan representatives and keep organized files of completed documentation.
  8. Monitor staff credentials and licenses.
  9. Performs other duties as assignedDuring a public health emergency, the employee may be required to perform duties similar to but not limited to those in the job description.


EDUCATION:  High school or GED required, post-secondary education in General Business or Health Care preferred.


  • Provider credentialing and re-credentialing knowledge preferred.
  • Previous experience in an administrative role is preferred.
  • Excellent verbal and written communication skills, attention to detail and high level of customer service skills.
  • Must be able to communicate effectively.
  • Federally Qualified Health Center experience preferred, but not required. 

OTHER REQUIREMENTS: Commitment and passionate about providing health care to individuals and families in medically underserved communities ● willingness to be flexible ● results driven ● ability to deal with sensitive information in a highly confidential manner ● effective communication skills, both written and oral with patients, staff, visitors, co-workers, community partners, funders and other regulatory agencies ● innovative thinker ● effective problem solver ● attentive to details ● able to work in a fast paced environment  ● self-starter ● takes initiative ● able to interpret data ● able to use software to generate reports.

Apply at: https://honorcommunityhealth.org/careers/ 

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