Senior Credentialing & Enrollment Specialist — Complex Cases

UC Health (Cincinnati); Cincinnati (OH); On-site; USD 65,000 - 95,000; Full time

Job summary

UC Health (Cincinnati) seeks a Sr Credentialing Specialist to manage complex credentialing and enrollment tasks for Medical and Allied Health staff. The role covers data processing, verifications, and regulatory updates across payors and jurisdictions.

The incumbent analyzes nonstandard requirements, coordinates with providers and departments, and maintains audit-ready records while driving process improvements and staff mentorship.

Qualifications

• High school diploma or GED required; an associate degree is preferred.
• CPCS certification is preferred to support credentialing work.
• Minimum eight years of progressive credentialing or enrollment experience in hospital, health system, or managed care.

Responsibilities

• Prepare and process credentialing applications and verifications for Medical and Allied Health staff.
• Independently manage complex credentialing and enrollment cases across multiple payors and jurisdictions.
• Complete CAQH, Cactus, and payor portal records accurately and audit-ready.
• Manage high-risk cases, coordinate with providers and departments, and report status to leadership.
• Oversee complex hospital affiliation, privileging activities, and regulatory maintenance.
• Support quality reviews, audits, and process improvement initiatives.
• Provide subject-matter guidance and mentorship to credentialing staff.

Skills

Credentialing

Enrollment

Regulatory

Data integrity

Mentoring

Education

High school diploma

Associate degree

CPCS (preferred)

Tools

CAQH

Cactus

Payor portals

Spreadsheets

Job description

UC Health (Cincinnati) seeks a Sr Credentialing Specialist to manage complex credentialing and enrollment tasks for Medical and Allied Health staff. The role covers data processing, verifications, and regulatory updates across payors and jurisdictions.

The incumbent analyzes nonstandard requirements, coordinates with providers and departments, and maintains audit-ready records while driving process improvements and staff mentorship.