Provider Credentialing & Data Specialist

Highmark; United States; On-site; USD 29,000 - 41,000; Full time

Job summary

Highmark Inc. is seeking a Credentialing Specialist to process provider applications, maintain the provider database, and coordinate credentialing verifications.

The role involves communicating with providers by phone and mail, handling initial enrollments, re-credentialing, and maintaining data accuracy within the Dental Provider File system. Responsibilities include credentialing and re-credentialing, vendor coordination, producing monthly reports, and supporting audits and process

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

• Credentials and re-credential providers.
• Contact providers by telephone or in writing to obtain information.
• Screen incoming applications for completeness and accuracy.
• Load provider data and credentialing information to databases.
• Manage credentialing inventory, reports and projects.
• Train credentialing team on systems, software, and procedures.
• Create and distribute monthly reports; handle complex issues.
• Support audits, business partners, internal departments and external clients.
• Represent department as the SME.

Skills

Microsoft Office

Communication skills

Provider data management

HIPAA awareness

Education

High School Diploma or GED

Tools

ULTRA

Dental Provider File system

Job description

Highmark Inc. is seeking a Credentialing Specialist to process provider applications, maintain the provider database, and coordinate credentialing verifications.

The role involves communicating with providers by phone and mail, handling initial enrollments, re-credentialing, and maintaining data accuracy within the Dental Provider File system. Responsibilities include credentialing and re-credentialing, vendor coordination, producing monthly reports, and supporting audits and process