Healthcare Credentialing Specialist - Detail-Oriented

PRIORITY MANAGEMENT GROUP INC in; Pawtucket (RI); On-site; USD 42,000 - 56,000; Full time

Job summary

Priority Management Group Inc in Pawtucket, RI is seeking a Credentialing Specialist to manage initial and re-credentialing applications in compliance with HIPAA, federal and state rules. The role emphasizes accuracy, confidentiality and timely processing.

You will screen applications, investigate discrepancies, maintain credentialing records, and support the Credentialing Team with administrative tasks while delivering superior service to providers.

Qualifications

• High School Diploma or GED required; Associate degree preferred.
• Experience in a medical office/healthcare administrative role.
• HIPAA policies and regulations knowledge.
• Proficient with Microsoft Office, internet resources and Adobe Acrobat.
• Strong interpersonal skills to communicate across levels.
• Fast learner with problem solving abilities.
• Able to organize, prioritize and complete work in a fast-paced setting.
• Reliable with extreme attention to detail and documentation.
• Strong customer service orientation.
• Ability to work independently and as part of a Credentialing Team.

Responsibilities

• Processing initial credentialing and re-credentialing applications per defined processes.
• Screening provider applications and supporting documentation for eligibility.
• Investigating and validating discrepancies and adverse information.
• Responding to external queries regarding provider status.
• Maintaining superior customer service to obtain documentation and complete applications.
• Verifying and documenting expirables.
• Maintaining credentialing database with current information for stakeholders.
• Maintaining confidentiality regarding disciplinary actions or malpractice.
• Assisting the Credentialing Team with additional administrative tasks.

Skills

Attention to detail

Interpersonal skills

Organizational skills

Problem solving

Independent worker

Customer service

Education

High School Diploma or GED

Associate degree

Tools

Microsoft Excel

Job description

Priority Management Group Inc in Pawtucket, RI is seeking a Credentialing Specialist to manage initial and re-credentialing applications in compliance with HIPAA, federal and state rules. The role emphasizes accuracy, confidentiality and timely processing.

You will screen applications, investigate discrepancies, maintain credentialing records, and support the Credentialing Team with administrative tasks while delivering superior service to providers.