Credentialing Specialist

Description

Manage the end-to-end credentialing process for behavioral health clinicians, including initial credentialing, re-credentialing, and ongoing monitoring. Develop and maintain a comprehensive Standard Operating Procedure (SOP) to guide current and future credentialing staff. Ensure timely and accurate data entry into the credentialing information system, maintaining up-to-date and complete provider files. Communicate with clinicians, licensing boards, insurance companies, and other stakeholders to obtain and verify credentialing information. Monitor expiration dates for licenses, certifications, and other credentials, ensuring timely renewals. Maintain strict confidentiality of all credentialing files and sensitive information. Collaborate with HR, compliance, and clinical leadership to ensure alignment with organizational policies and regulatory requirements. Participate in audits and prepare documentation as needed for internal and external reviews. Identify and implement process improvements to enhance the efficiency and accuracy of credentialing workflows. Provide training and support to new team members or temporary staff involved in credentialing activities. Stay current with industry standards, payer requirements, and state/federal regulations related to credentialing.

Skills

provider credentialing, medical terminology, organizational and analytical skills, Behavioral Health, credentialing, oracle, provider enrollment

Top Skills Details

provider credentialing,medical terminology,organizational and analytical skills,Behavioral Health,credentialing

Additional Skills & Qualifications

Minimum of 2–3 years of experience in behavioral health credentialing or a related healthcare credentialing role. Familiarity with credentialing software and systems (e.g., CAQH, NPPES, PECOS). Strong understanding of regulatory and accreditation standards (e.g., NCQA, Joint Commission). Excellent written and verbal communication skills. High attention to detail and strong organizational skills. Ability to work independently and manage multiple priorities in a fast-paced environment. Proficiency in Microsoft Office Suite (Word, Excel, Outlook).

Experience Level

Intermediate Level