Credentialing Specialist — Provider Data & Networks

Embedded Shishya; United States; Remote; USD 29,000 - 41,000; Full time

Job summary

Highmark Inc. is seeking a Credentialing Specialist to process provider applications, perform credentialing, and manage provider data. You will communicate with providers by phone and mail, screen applications for accuracy, and load credentialing information into the provider database.

You may train other staff and support audits and projects. Key responsibilities include handling complex credentialing tasks, maintaining inventories, and ensuring timely completion of reports while adhering to

Qualifications

• High School Diploma or GED required.
• 3-5 years of related, progressive experience.
• Experience in Provider Data Management, Customer Services or Claims.
• Microsoft Office experience (Word, Excel, PowerPoint).

Responsibilities

• Credential and re-credential providers.
• Contact providers by phone or mail to obtain information.
• Screen applications for completeness and accuracy.
• Perform credentialing verifications and load data to provider databases.
• Manage credentialing inventory, reports and projects to deadlines.
• Train credentialing team on systems and procedures.
• Create and distribute monthly reports and handle complex issues.
• Support audits, partners, internal departments and clients.
• Represent the department as the subject matter expert.
• Research documentation for audits and respond to updates from partners.

Skills

Provider data management

Customer service

Credentialing

Communication

Microsoft Office

Education

High School Diploma or GED

Tools

ULTRA

Dental Provider File

Job description

Highmark Inc. is seeking a Credentialing Specialist to process provider applications, perform credentialing, and manage provider data. You will communicate with providers by phone and mail, screen applications for accuracy, and load credentialing information into the provider database.

You may train other staff and support audits and projects. Key responsibilities include handling complex credentialing tasks, maintaining inventories, and ensuring timely completion of reports while adhering to