Job Description

Credentialing Specialist Key Responsibilities: Verification and Documentation:

• Thoroughly verify the credentials, licenses, certifications, and qualifications of healthcare professionals.
• Ensure all documentation is accurate, complete, and up to date.
• Maintain detailed records of provider information in online databases and systems.

Compliance and Regulations:

• Ensure compliance with federal, state, and regional regulations and standards related to credentialing.
• Stay informed about changes in regulations and policies.

Application Processing:

• Prepare, submit, and maintain enrollment, credentialing, and recredentialing applications for healthcare providers.
• Audit applications for accuracy and completeness.

Communication and Follow-up:

• Communicate with providers, insurance companies, and other stakeholders to address credentialing issues and ensure timely processing.
• Follow up on application progress and resolve any issues.

Database Management: • Maintain accurate provider profiles. Other Duties:

• Participate in the development of internal credentialing processes.
• Prepare reports and scoring required by regulatory and accrediting agencies.
• Perform miscellaneous job-related duties as assigned.

Required Skills and Qualifications: Education: A high school diploma or equivalent is typically required, with some employers preferring an associate or bachelor's degree in a related field. Experience: Experience in credentialing, privileging, or other medical experience relevant to insurance carrier credentialing is preferred. Technical Skills: Strong computer skills, including proficiency in database management and relevant software. Other Skills: Excellent communication, organizational, and problem-solving skills are essential. Carolinas Center For Oral & Facial Surgery

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