Provider Credentialing Specialist

Highmark Health; Northern (KY); Hybrid; USD 29,000 - 41,000; Full time

Job summary

Highmark Health seeks a Credentialing Specialist to process provider applications and re-applications, maintain the provider database, and communicate credentialing status to providers by phone and mail. The role includes credentialing, re-credentialing, and related verification activities for group practices as applicable.

Responsibilities include training credentialing staff, generating monthly reports, supporting audits, and ensuring compliance with HIPAA and privacy policies.

Qualifications

• High School Diploma or GED is required.
• 3-5 years of related, progressive experience.
• Experience in Provider Data Management, Customer Services or Claims.
• Microsoft Office experience (Word, Excel, PowerPoint, etc.)

Responsibilities

• Credentials and re-credential providers.
• Contact providers or representatives by telephone or in writing to obtain additional information while processing enrollment applications.
• Screen incoming applications and paperwork for completeness and accuracy.
• Load provider to appropriate networks and credentialing information to the provider database.

Skills

Provider Data Management

Customer Services

Claims processing

Microsoft Office

Education

High School Diploma or GED

Tools

ULTRA

Dental Provider File systems

Job description

Highmark Health seeks a Credentialing Specialist to process provider applications and re-applications, maintain the provider database, and communicate credentialing status to providers by phone and mail. The role includes credentialing, re-credentialing, and related verification activities for group practices as applicable.

Responsibilities include training credentialing staff, generating monthly reports, supporting audits, and ensuring compliance with HIPAA and privacy policies.