Provider Credentialing Specialist

Triple-S Management Corp.; Guaynabo, Northern (PR, KY); Hybrid; USD 40,000 - 52,000; Full time

Job summary

Triple-S Management Corp. in Puerto Rico seeks a credentialing professional to support provider enrollment and credentialing activities. The role focuses on collecting documentation, maintaining records, and ensuring regulatory compliance.

You will collaborate with internal teams and providers to obtain required information, update systems, and generate reports that track credentialing metrics. A Associate's Degree and 1–3 years of experience are preferred.

Qualifications

• Requires an Associate's Degree or higher.
• 1–3 years of related experience in credentialing.
• Knowledge of CMS, URAC, ASEs and regulatory requirements.

Responsibilities

• Review provider applications and ensure documentation is complete.
• Coordinate information from internal and external sources for credentialing.
• Update credentialing records in tracking systems.
• Contact providers to obtain missing documents.
• Prepare reports on credentialing activities to support metrics.
• Audit credentialing files for regulatory compliance.
• Maintain confidentiality of provider information.
• Serve as primary contact for credentialing inquiries.
• Participate in system/process enhancements for credentialing.
• Perform additional tasks as assigned.

Skills

Action Oriented

Manages Ambiguity

Education

Associate's Degree

Job description

Triple-S Management Corp. in Puerto Rico seeks a credentialing professional to support provider enrollment and credentialing activities. The role focuses on collecting documentation, maintaining records, and ensuring regulatory compliance.

You will collaborate with internal teams and providers to obtain required information, update systems, and generate reports that track credentialing metrics. A Associate's Degree and 1–3 years of experience are preferred.