Credentialing Specialist

Visionunlimited; Northern (KY); Hybrid; USD 42,000 - 64,000; Full time

Job summary

Visionunlimited is seeking a Credentialing Specialist to manage provider credentialing and enrollment processes, ensuring timely submission of documents. You will handle data synchronization, CAQH documentation, and coordination with payers while staying compliant with state rules.

This role requires night shifts, strong English communication, and proficiency with Word and Excel.

Qualifications

• Experience in provider credentialing and enrolment.
• Knowledge of CAQH documentation and applications.
• Strong English communication, both written and spoken.
• Proficiency with Microsoft Word and Excel.
• Ability to work night shifts and meet deadlines.

Responsibilities

• Track and follow up with providers for credentialing documents and applications.
• Synchronize data across multiple systems.
• Maintain credentialing database and process tracking.
• Document progress in project management software and report updates to management.
• Coordinate credentialing/enrolment with payers for various provider types.
• Stay compliant with licenses, verification, and state bylaws.
• Follow SOPs and communicate issues and trends to management.
• Perform other duties as assigned.

Skills

US healthcare landscape knowledge

Medical billing basics

CAQH proficiency

Provider credentialing

Hospital admitting privileges

Planning and prioritization

MS Word & Excel

English communication

Night shift adaptability

Education

Graduate with relevant work experience

Tools

CAQH

Job description

Role & responsibilities

• Track and follow up with providers for timely return of all required credentialing documents and applications
• Assist in synchronization of data among multiple systems
• Maintain credentialing database and ensure up-to-date tracking of application process
• Document progress in project management software, and provide regular updates to management
• Work with commercial and governmental payers for credentialing and enrolment of multiple provider specialties and facility types
• Stay up to date on licensing, verification, and state specific rules and bylaws to maintain compliance
• Display in depth knowledge of and execution of all standard operating procedures (SOPs) as well as communicating issues, trends, concerns, and suggestions to management
• Perform other duties as assigned

Preferred candidate profile

• Strong knowledge of the US healthcare landscape
• Basic medical billing and payer network skillset required
• Thorough knowledge of CAQH, with ability to document and prepare applications for healthcare providers
• Intermediate knowledge of provider hospital credentialing and hospital admitting privileges
• Ability to plan, prioritize, and complete work to meet established objectives
• Highly proficient with computers, especially Word and Excel
• Excellent written and oral English communication skills
• Positive attitude and an outgoing personality
• Ability to work night shifts

Experience: More than 1 years experience in provider credentialing and enrolment

Qualification: Graduate with relevant work experience required

Shifts: Night Shift (6:30 pm 4:00 am) Monday to Friday