Delegated Credentialing Specialist II - Managed Care - Days - FT

Memorial Hospital at Gulfport; Biloxi (MS); On-site; USD 42,000 - 62,000; Full time

Job summary

Memorial Hospital at Gulfport seeks a Delegated Credentialing Specialist II for a day shift in a full-time capacity. You will ensure physicians and providers are credentialed with delegated plans, monitor compliance, and maintain accurate data across databases.

The role involves coordinating provider enrollments, audits, and onboarding activities. The position requires 2 years of credentialing experience, CPCS certification, and strong written and verbal communication.

Qualifications

• Requires an Associate degree in Business or healthcare field; experience may be accepted in lieu of degree requirement.
• Preferred: Bachelor's Degree in Business or Healthcare field.
• Certification: Certified Provider Credentialing Specialist (CPCS) is preferred/required.
• Experience: 2 years direct credentialing experience.
• Skills: Strong verbal and written communication, data entry accuracy, database management.

Responsibilities

• Compile and complete physician/provider credentialing forms for payor delegations.
• Coordinate enrollment applications and credentialing files with payors and providers.
• Maintain credentialing databases and track license/certification expirations.
• Assist with audits and post-audit resolutions with insurance representatives.
• Support provider onboarding by obtaining necessary information/signatures.

Education

Associates degree in Business or healthcare related field

Bachelor's Degree in Business or Healthcare related field

Job description

Delegated Credentialing Specialist II - Managed Care - Days - FT

Job Description

The Delegated Credentialing Specialist II is responsible for ensuring that all employed Memorial physicians and providers are credentialed with the appropriate delegated insurance plans, governmental agencies and any other participating insurance plans. The Specialist II oversees the preparation and processing of information and monitors compliance with regulatory and accrediting bodies as well as delegated rules and regulations. The Specialist II maintains accurate and up to date data within the relevant databases.

Responsibilities

• Responsible for compiling and completing physician and provider credentialing forms for appropriate payor delegations
  • Initiates the verification and documentation processes for submitted applications
  • Coordinates completion of physician and provider participating applications and credentialing files
  • Collaborates with insurance plan providers and representatives to obtain and complete specific payer credentialing forms and applications
• Responsible for preparing and providing information to various departments and external entities
  • Communicates with appropriate billing staff regarding the status of a provider's enrollment with individual payers
  • Facilitates provider-related research based on suspended claims, denial issues related to the enrollment process and other feedback opportunities
  • Provides requested information to authorized agencies for audits and reviews
  • Ensures compliance with delegation monitoring and oversight requirements for credentialing functions
  • Collaborates with the various departments to conduct the timely credentialing delegation audits
  • Performs the post-audit results meetings with insurance representatives and contributes to the resolution of any audit findings
  • Attends provider onboarding to obtain additional information/signatures from providers
• Maintains and updates physicians and provider information in the applicable databases
  • Maintains credentialing database and provider billing number tracking sheet
  • Monitors and tracks license and certification expirations and renewals and provider information
  • Maintains physician and provider directory information for departments and hospital
  • Performs tracking and follow-up to ensure provider numbers are linked to appropriate entity and location

Qualifications

Education:

• Required - Associates degree in Business or healthcare related field; Experience may be accepted in lieu of degree requirement
• Preferred - Bachelor's Degree in Business or Healthcare related field

Certification:

• Required - Certified Provider Credentialing Specialist (CPCS) from the National Association of Medical Staff Services

Experience:

• 2 years Directly related credentialing experience

Skills:

• Strong verbal and written communication skills
• Data entry with minimal errors
• Database management
• Seeking solutions using appropriate methodologies

Job Info

• Job Identification 28930
• Job Category Clerical & Admin Support
• Posting Date 08/13/2026, 04:37 PM
• Job Schedule Full time
• Job Shift Day
• Locations Biloxi Annex 220 Popps Ferry Road