Credentialing Specialist II - Multi-Payor Enrollments

UC Health; Cincinnati (OH); On-site; USD 45,000 - 65,000; Full time

Job summary

UC Health in Cincinnati, OH is seeking a Credentialing Specialist to manage credentialing and enrollment for Medical and Allied Health staff. You will prepare applications, verify documentation, and ensure compliance across multiple payors.

You will coordinate with providers and internal teams to maintain timely enrollments, accurate data, and compliant records, while delivering professional support to stakeholders.

Qualifications

• High School diploma or GED required.
• CPCS (Certified Provider Credentialing Specialist) preferred.
• 4–8 years of credentialing experience in hospital, physician office, or managed care.

Responsibilities

• Independently manages credentialing and enrollment applications from receipt through completion for Medical and Allied Health staff across multiple payors.
• Collects, validates, and analyzes provider information and supporting documentation to determine completeness and compliance with established requirements.
• Completes paper and electronic applications, CAQH and Cactus updates, spreadsheets, and payor portal submissions with minimal supervision.
• Monitors application status, responds to requests for additional information, resolves routine discrepancies, and escalates high-risk or nonstandard barriers.
• Coordinates activity across providers, internal departments, payors, and external entities to meet enrollment and maintenance deadlines.
• Independently processes provider terminations, practice location additions, changes, and terminations across multiple payors and systems.
• Maintains provider/payor participation (PAR), taxonomy, specialty, demographic, name, licensure, DEA, malpractice, and related enrollment records, resolving routine cross-system discrepancies.
• Coordinates hospital affiliation and privileging activities, including initial appointments, reappointments, and required maintenance documentation.
• Manages assigned maintenance cases end to end, including status tracking, documentation, follow-up, issue resolution, and timely escalation of unresolved risks.
• Reviews and responds to payor notices, directory requests, and incoming correspondence requiring interpretation, coordination, or multi-step follow-up.
• Independently completes state-specific Medicare and Medicaid enrollment maintenance, revalidations, recertifications, and related updates according to program requirements.
• Interprets routine regulatory and payor requirements, maintains supporting records, and coordinates corrections when submissions or provider records do not meet requirements.
• Maintains proficiency across assigned workflows, participates in cross-training, and shares process knowledge with team members.
• Provides practical guidance on established procedures and supports coverage for multiple maintenance functions.
• Provides timely, accurate, and professional support to providers, payors, internal departments, and other customers.
• Anticipates follow-up needs, communicates status clearly, and resolves routine service issues within established authority.
• Maintains complete, accurate, confidential, and audit-ready electronic and paper records.
• Participates in data cleanup, operational projects, correspondence coverage, and other assigned departmental duties.

Skills

Credentialing experience

Attention to detail

Communication skills

Education

High School diploma or GED

CPCS certification preferred

Job description

UC Health in Cincinnati, OH is seeking a Credentialing Specialist to manage credentialing and enrollment for Medical and Allied Health staff. You will prepare applications, verify documentation, and ensure compliance across multiple payors.

You will coordinate with providers and internal teams to maintain timely enrollments, accurate data, and compliant records, while delivering professional support to stakeholders.