Credentialing Specialist II, PBO, Full Time, First Shift

UC Health•Cincinnati, OH

17h

About The Position

This is a multifaceted position combining administrative work, customer service, and credentialing verifications. The Credentialing Specialist II prepares, documents, and completes credentialing processes for Medical and Allied Health staff, including applications and verifications. The role compiles provider data, prepares applications, maintains organized files, and keeps provider documents and enrollments current. The specialist independently manages credentialing and enrollment applications from receipt through completion across multiple payors. The role also maintains provider enrollment records and coordinates hospital affiliation and privileging activities. It includes Medicare and Medicaid maintenance, revalidations, and recertifications; coordination with providers, internal departments, payors, and external entities; and timely follow-up and escalation of unresolved issues. The specialist supports customers, maintains complete and audit-ready confidential records, participates in cross-training and operational projects, and provides practical guidance on established procedures. UC Health describes itself as the region’s adult academic health system, focused on innovation, world-class care, advancing healing, and reducing suffering.

Requirements

High school diploma or GED.
4–8 years of credentialing experience in a hospital, physician office, or managed care setting.

Nice To Haves

Certified Provider Credentialing Specialist (CPCS) certification preferred.

Responsibilities

Independently manage credentialing and enrollment applications for Medical and Allied Health staff across multiple payors, from receipt through completion.
Collect, validate, and analyze provider information and supporting documentation for completeness and compliance.
Complete paper and electronic applications, CAQH and Cactus updates, spreadsheets, and payor portal submissions with minimal supervision.
Monitor application status, respond to requests for additional information, resolve routine discrepancies, and escalate high-risk or nonstandard barriers.
Coordinate activity among providers, internal departments, payors, and external entities to meet enrollment and maintenance deadlines.
Process provider terminations and practice location additions, changes, and terminations across multiple payors and systems.
Maintain provider and payor participation, taxonomy, specialty, demographic, name, licensure, DEA, malpractice, and related enrollment records; resolve routine cross-system discrepancies.
Coordinate hospital affiliation and privileging activities, including initial appointments, reappointments, and required maintenance documentation.
Manage assigned maintenance cases end to end, including status tracking, documentation, follow-up, issue resolution, and escalation of unresolved risks.
Review and respond to payor notices, directory requests, and correspondence requiring interpretation, coordination, or multi-step follow-up.
Complete state-specific Medicare and Medicaid enrollment maintenance, revalidations, recertifications, and related updates according to program requirements.
Interpret routine regulatory and payor requirements, maintain supporting records, and coordinate corrections when submissions or provider records do not meet requirements.
Maintain proficiency across assigned workflows, participate in cross-training, share process knowledge, provide practical guidance on established procedures, and support coverage for multiple maintenance functions.
Provide timely, accurate, and professional support to providers, payors, internal departments, and other customers; communicate status clearly and resolve routine service issues within established authority.
Maintain complete, accurate, confidential, and audit-ready electronic and paper records.
Participate in data cleanup, operational projects, correspondence coverage, and other assigned departmental duties.