Credentialing Specialist

Credentialing Specialist

Location: Columbus, OH 43235
Salary: $41,600 annually

Position Overview

A growing healthcare organization in the Columbus area is seeking a detail-oriented Healthcare Commercial Credentialing Specialist to support provider enrollment, credentialing, and ongoing maintenance activities. This role is responsible for ensuring provider records remain current and compliant across commercial, Medicare, and Medicaid payers while managing multiple online credentialing platforms and databases.

The ideal candidate will have prior healthcare credentialing experience, strong organizational skills, and the ability to manage multiple deadlines in a fast-paced environment.

Key Responsibilities

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• Maintain and update provider credentialing files and records.
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• Process provider enrollments, re-credentialing, and demographic updates with commercial, Medicare, and Medicaid insurance payers.
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• Access and manage multiple payer portals and credentialing systems.
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• Retrieve, verify, and organize provider documentation from cloud-based storage systems.
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• Utilize CAQH and other credentialing databases to obtain and maintain provider information.
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• Prepare and manage provider rosters and enrollment submissions.
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• Track credentialing applications and follow up with payers to ensure timely processing.
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• Monitor provider expirables, including licenses, certifications, malpractice insurance, and other required documentation.
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• Ensure compliance with payer, regulatory, and organizational requirements.
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• Collaborate with internal departments to resolve enrollment and credentialing issues.
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• Maintain accurate records and provide status updates on credentialing activities.
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• Assist with audits and reporting related to provider credentialing and enrollment.
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Required Qualifications

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• Previous healthcare credentialing experience.
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• Experience working with Medicare and Medicaid credentialing and enrollment processes.
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• Knowledge of insurance industry terminology, payer enrollment, and provider credentialing requirements.
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• Ability to navigate and manage multiple online portals and cloud-based systems.
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• Strong attention to detail and organizational skills.
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• Proficiency with Microsoft Office applications and data entry.
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• Excellent communication and follow-up skills.
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Preferred Qualifications

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• Commercial credentialing experience.
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• Experience using CAQH and provider roster management tools.
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• Familiarity with provider enrollment workflows and payer relations.
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• Experience working in a healthcare administration, medical billing, or insurance environment.
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