Credentialing Specialist

Ontario Trillium Foundation; Hammond (LA); On-site; USD 45,000 - 65,000; Full time

Job summary

Ontario Trillium Foundation is seeking a Credentialing Specialist to verify healthcare providers' licenses, certifications, and registrations, ensuring regulatory compliance and accurate records. You will manage credentialing workflows and support enrollment and recredentialing activities.

This role emphasizes meticulous data management, proactive communication with providers, and coordination with insurers and facilities to resolve discrepancies and maintain up-to-date credentials.

Qualifications

• Experience in healthcare credentialing or related field.
• Ability to verify licenses, certifications and registrations.
• Maintain accurate credentialing records and renewals.
• Coordinate enrollment, credentialing and recredentialing processes.
• Effective communication with providers.

Responsibilities

• Maintain licensing, credentials and insurance records.
• Credential verification: review and authenticate credentials, qualifications, licenses and certifications of healthcare providers to ensure accuracy and compliance with regulatory standards.
• Database management: update credentialing spreadsheets and track expiration dates to ensure timely renewals.
• Documentation: prepare and maintain documentation for enrollment, credentialing, and recredentialing of healthcare providers for insurance companies as well as facilities.
• Communication: liaise with healthcare providers to address discrepancies or missing information in their applications.

Skills

Credential verification

Database management

Attention to detail

Communication

Tools

Spreadsheets (Excel)

Credentialing software

Job description

Credentialing Specialist

Responsible for verifying the qualifications of healthcare professionals, ensuring compliance with industry standards, and maintaining accurate records of credentials.

• Maintain licensing, credentials and insurance records.
• Credential verification: review and authenticate credentials, qualifications, licenses and certifications of healthcare providers to ensure accuracy and compliance with regulatory standards.
• Database Management: Maintain and update credentialing spreadsheets, tracking expiration dates of license and certification to ensure timely renewals.
• Documentation: Prepare, submit and maintain documentation for enrollment, credentialing, and recredentialing of healthcare providers for insurance companies as well as facilities.
• Communication: Liaise with healthcare providers to address discrepancies or missing information in their applications.