Medical Credentialing Specialist

UC Health; Cincinnati (OH); On-site; USD 42,000 - 64,000; Full time

Job summary

UC Health in Cincinnati, OH seeks a Credentialing Specialist for Medical Staff Office. This is a full-time, first-shift role handling credentialing verifications, data processing, payor enrollment files, and provider communications.

You will prepare applications, maintain records, update CAQH and payor portals, and support enrollment reviews with accuracy and discretion. Qualifications include a high school diploma or GED (CPCS preferred) and 1–4 years in a business office, healthcare

Qualifications

• Minimum Required: High School diploma or GED.
• Preferred: CPCS (Certified Provider Credentialing Specialist) certification.
• Experience: 1 to 4 years of experience in a business office setting required. Healthcare and credentialing experience in a hospital, physician practice, or managed care environment preferred.

Responsibilities

• Prepares, documents, and completes credentialing data processes.
• Performs regularly recurring administrative tasks for maintaining Payor Enrollment data files.
• Training and Self Development.
• Customer Service.
• Maintains Payor Enrollment data files to support effective entry, filing, storage, and retrieval of data and documents.
• Assists department with performance improvement activities, clean up projects, and other duties as assigned.
• Communicates with providers to gather information needed to enroll them with payors.
• Update CAQH and Cactus database with new provider information.
• Collates information and prepares credentialing files for review
• Populate paper applications, Excel documents and online websites/portals to enroll providers.
• Follows up on applications submitted.
• Respond to requests for additional information needed for enrollments.
• Submit revalidation/recertification applications every three to five years to maintain provider enrollments.
• Respond to notices from payors needing information to maintain enrollments and payor directories.
• Reattest CAQH every 120 days for all providers.
• Submit license, DEAs and malpractice to payors to maintain enrollments.
• Update CAQH and Cactus with demographic and name changes and submit updates to all payors.
• Receives, opens, sorts and distributes mail/emails.
• Participate in staff training that aligns with recognized improvement opportunities.
• Work with supervisors and coworkers to learn all parts of the Enrollment Team.
• Makes customer service a high priority. Listens to, identifies, and responds quickly and appropriately to customer needs, both internal and external customers
• Respond in timely manner
• Execute required actions
• Identify potential problems
• Handles confidential materials
• Maintain storage of files for orderly retrieval.

Job description

UC Health in Cincinnati, OH seeks a Credentialing Specialist for Medical Staff Office. This is a full-time, first-shift role handling credentialing verifications, data processing, payor enrollment files, and provider communications.

You will prepare applications, maintain records, update CAQH and payor portals, and support enrollment reviews with accuracy and discretion. Qualifications include a high school diploma or GED (CPCS preferred) and 1–4 years in a business office, healthcare