Credentialing Specialist - Healthcare

Job at a Glance

Title: Credentialing Specialist
Location:  Columbia, SC 29229
Contract: W2 only
Pay: $20 /hour + optional medical, dental, vision, 401(k) match

Overview

Responsible for managing the initial credentialing and re-credentialing process of healthcare providers to the network across various lines of business. Maintains accurate provider databases, ensures compliance with industry standards, and supports internal teams and external partners with network documentation. This role requires high organization, research skills, and adherence to strict industry regulations.

Key Responsibilities

• Performs initial and re-credentialing of providers/practitioners including documenting credentialing information according to established policies/procedures. Completes primary verification of the following: state licensure, state/federal controlled substance certification, educational and/or residency background, malpractice coverage/history, hospital privileges, and previous sanctions.
• Maintains credentialing database and HCS data files with appropriate network indicators and effective dates. Ensures provider databases are kept current and accurate. Retrieves and interprets credentialing database information for use in various reports.
• Communicates (both verbally and in written form) with providers, provider relations, marketing, other credentialing departments, and various management staff relating to any urgent matters. Registers all participating providers and assists provider network personnel in maintaining and/or updating directory information. Responds to calls/correspondence from physician/provider/office staff regarding participating networks, directories, and provider credentialing. Ensures communication of provider profiling and performance information with other provider services areas. Prepares correspondence and credentialing reports as requested by management.
• Assembles necessary information on providers due initial credentialing or re-credentialing for presentation to credentialing committee. Attends meetings of credentialing committee as scheduled. Assists in research, redevelopment, and implementation of any new programs/projects. Performs quality control checks/reviews/oversight of delegated entities including traveling as required to perform credentialing delegation audits. Present delegated audit findings to credentialing committee.

Required Skills

• Must have 2 years experience in either healthcare or health insurance
• Microsoft Office skills
• Research experience
• High level of computer skills
• Highly organized
• Experience with re-credentialing
• Communicates with impact
• Manages database files for reporting
• Understands credentialing provider lifecycle

Required Education

• Associate's Degree or Two years of related work experience

Preferred Skills

• No additional preferred skills specified

Why Should I Apply?

This role offers an opportunity to be a key part of healthcare provider credentialing, ensuring compliance and accuracy within a vital network process. It is ideal for candidates with healthcare or insurance industry experience seeking a stable, impactful position.

About CEI:
As a trusted technology partner, CEI delivers solutions that help our customers transform their business and achieve meaningful results. From strategy and custom application development through application management - our technology and digital experience services are tailored to meet each unique need of our customers. Our staffing solutions bring specialized skills to complement our customers' workforce and project requirements.

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