Job Description

Job Description

Our client, a rapidly expanding private healthcare company in Pottstown, PA, is looking for a Credentialing Specialist.

This is an exciting opportunity to be part of a high-growth environment where you’ll play a key role in building the Credentialing and Provider Enrollment team.

The Credentialing Specialist/Provider Enrollment position is responsible for ensuring that healthcare providers are properly credentialed and in compliance with all regulatory and organizational standards. This role involves verifying the credentials, licensures, certifications, and background of medical professionals to maintain compliance with industry standards and legal regulations.

***This is an on-site role

***Located in Pottstown, PA

***Local candidates only

Responsibilities include:

• Credential newly hired clinicians with applicable insurance payers for timely billing.
• Collect, Submit, & Track all necessary documentation.
• Process re-credentialing for existing clinicians as required by individual payers.
• Maintain a current, accurate database of all clinicians’ credentialing / licensure status, needs, expirations, issues, etc. Share with internal staff as applicable.
• Communicate & Coordinate with all levels of internal staff & external stakeholders to ensure timely & consistent qualification is met & maintained.
• Monitor expiring credentials to ensure ongoing compliance with regulatory guidelines.
• Investigate and resolve any issues that arise during the approval process.
• Under the direction of leadership, assist with site level enrollments or changes to contract.

Requirements

• Strong experience in healthcare credentialing and/or provider enrollment.
• Associate's or Bachelor's degree.
• Familiarity with credentialing software and platforms (eg.; CAQH, PECOS, Availity).
• Experience credentialing across multiple states as well as across Commercial and Medicaid payors

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