Credentialing Specialist

Jobtailor; New Berlin (WI); On-site; USD 55,000 - 75,000; Full time

Job summary

Jobtailor is seeking a Credentialing Specialist to manage administrative duties for payer accounts, including credentialing and licensing activities, for government-funded and commercial plans. You will coordinate applications, monitor progress, and support leadership with policy updates and reference materials.

The role requires several years in credentialing or related business functions, proficiency in Microsoft Office, and strong communication skills to engage across organizational levels.

Qualifications

• High School Diploma or GED required
• 3+ years of experience in the business field (within last 5 years)
• 1+ year of Medical Credentialing and Licensing experience (within last 24 months) preferred
• Bachelor’s Degree preferred
• CPCS certification preferred
• Proficient in Microsoft Office and able to quickly learn and navigate new systems and technologies
• Strong verbal and written communication skills across all levels of the organization

Responsibilities

• Manage administrative duties for all government-funded and commercial payer accounts (web portal access, demographic updates, licensure updates and renewals)
• Process and complete credentialing/re-credentialing applications for all government-funded health plans; monitor the applications and follow-up as needed
• Assist the Contract & Credentialing Manager with applications or credentialing initiatives for the commercial contracts and health plans
• Maintain and update contract-related reference sheets, job aids, tracking sheets and reference guides and assist leadership with distributing companywide internal communications regarding new payer contracts or policy changes

Skills

Strong verbal and written comms

Microsoft Office proficiency

Adaptability / quick learner

Education

High School Diploma or GED

Bachelor’s Degree preferred

CPCS certification preferred

Tools

Microsoft Office

Job description

Responsibilities

• Manage the administrative duties for all government-funded and commercial payer accounts (web portal access, demographic updates, licensure updates and renewals)
• Process and complete any credentialing/re-credentialing applications for all government-funded health plans; monitor the applications and follow-up as needed
• Assist the Contract & Credentialing Manager with any applications or credentialing initiatives for the commercial contracts and health plans
• Maintain and update any contract-related reference sheets, job aids, tracking sheets and reference guides as well as assisting leadership with distributing any companywide internal FYI communications regarding new payer contracts or policy changes

Requirements

• High School Diploma or G.E.D
• Minimum of 3 years of experience in the business field (within the last 5 years)
• 1+ year of Medical Credentialing and Licensing experience (within the last 24 months) preferred
• Bachelor’s Degree preferred
• Certified Provider Credentialing Specialist (CPCS) preferred
• Proficient in Microsoft Office and able to quickly learn and navigate new systems and technologies
• Strong verbal and written communication skills with the ability to convey information clearly and professionally across all levels of the organization