Specialist, Credentialing

The-Wright-Centers-For-Community-Health-and-Graduate-Medical-Education; Scranton (Lackawanna County); Hybrid; USD 52,000 - 66,000; Full time

Job summary

The Wright Center for Community Health and Graduate Medical Education is seeking a Credentialing Specialist to manage initial credentialing, re-credentialing, and privileging for physicians, nurse practitioners, physician assistants, and other providers. The role involves maintaining CAQH/NPI documentation, coordinating with payors, and overseeing licenses, DEAs, and CME records.

The position requires strong organizational skills, ability to work with internal teams and external agencies, and

Qualifications

• Bachelor or Associate degree in any healthcare related field or equivalent experience.
• 2+ years of experience in medical credentialing, payor enrollment, or related healthcare setting.
• Working knowledge of medical terminology, insurances and billing.

Responsibilities

• Maintain credentialing, competency, and expirable files for all providers.
• Onboard new providers and ensure checklist items are up to date.
• Enroll providers and clinic locations with state Medicaid agencies and payors.

Skills

Communication skills

Excel and data management

Time management

Detail oriented

Independent worker

Education

Bachelor or Associate degree in healthcare

Tools

Electronic Medical Records

Job description

This position primarily reports in person to our Scranton office and may require travel between clinics as needed. Ideal candidates would be local or willing to relocate upon offer.

The Credentialing Specialist is responsible for all aspects of the initial credentialing, re-credentialing, privileging and overseeing the credentialing portion of the new hire onboarding process for all incoming Physicians, Nurse Practitioners, Physician Assistants and other providers as necessary. Responsible for the application process which includes maintenance of the online application site (CAQH, NPI, etc) forms repository and intake, review and appropriate routing of all credentialing documents. Responsible for the insurance enrollment and facility credentialing. This position liaises with both internal teams and external agencies such as Hospitals, insurance companies, and other programs as needed. In addition to credentialing of providers, the position will maintain certifications, licenses, DEAs and CMEs for medical staff.

Work is performed in an office environment however, this position may offer a hybrid work option with departmental approval on a temporary or ongoing basis, allowing for remote work. Onsite presence is required for projects or team meetings as needed and onsite training is required.

Accountable for satisfying all job specific obligations and complying with all organization policies and procedures. The specific statements for this job description are not intended to be all inclusive. They represent typical elements considered necessary to successfully perform the job.

REPORTING RELATIONSHIPS

This position reports to the Credentialing Manager. This position works closely with the Revenue Cycle Department. This position has no direct reports.

ESSENTIAL JOB DUTIES AND FUNCTIONS

• Maintain accurate credentialing, competency, and expirable files in an orderly and current manner for all providers. Record all credentials information immediately upon receipt.
• Onboard new providers to ensure all checklist items are completed and up to date
• Enroll providers and clinic locations with state Medicaid agencies and other payors
• Coordinate new office openings and update payer/internal rosters
• Own, track, and manage Medicare, Medicaid, and other third‑party public and private payor, facility, and provider enrollment and credentialing
• Develop and maintain relationships with new and existing third‑party payors credentialing counterparts and departments
• Track, organize, and provide timely updates for all credentialing applications
• Problem‑solve, troubleshoot, and research credentialing issues independently
• Create and update training guides, Standard Operating Procedures (SOPs), announcements, and other documentation for the credentialing department
• Monitor, track, and complete re‑credentialing for individual providers and locations and ensure timely submissions
• Communicate updates and special requests to internal teams cross‑functionally
• Support the development of SOPs and assist the revenue cycle management team with credentialing related system errors and issues
• Coordinate with Human Resources and Employee Health to gather all necessary information to complete credentialing and privileging forms/applications
• Prepare for internal and external audits conducted for current and accurate provider information
• Communicate frequently with external stakeholders (ex. payors, state/federal agencies, and certifying bodies) for application updates, status changes, and resolution of any issues
• Maintain confidentiality of credentialing information
• Maintain certifications (ACLS, BLS, PALS, etc.), CMEs, licenses and DEAs for all faculty and clinical staff
• Improve professional growth and knowledge related to job‑specific competencies.
• Independently seeks out and utilizes information resources
• Participate in the design, implementation, and ongoing management of performance improvement activities
• Other duties as assigned by management

REQUIREMENTS

• Bachelor or Associate degree in any healthcare related field or equivalent experience
• 2+ years of experience in medical credentialing, payor enrollment, working in a medical facility environment or other healthcare setting (Required)
• Working knowledge of medical terminology, insurances and billing
• Experience with electronic medical records
• Strong computer skills specifically Microsoft Excel and database management
• Excellent communication skills in one‑on‑one interactions, electrically and over the phone
• Ability to perform the role successfully in a high‑intensity environment
• Must be a time driven individual who can meet many deadlines with a variety of outside parties
• Must be extremely organized and successfully monitor multiple deliverables
• Must be focused, self directed and have demonstrated problem‑solving abilities
• Must be detail oriented, quality and precision focused
• Must demonstrate good judgment, professionalism and discretion
• Able to work both independently and part of a team
• Meet The Wright Center for Community Health and its affiliated entity The Wright Center for Graduate Medical Education People Analyzer Tool
• Buy in and experience working in the EOS model (strongly preferred)
• Mission‑oriented; represents the enterprise in a professional manner while demonstrating organizational pride