Credentialing Specialist II, PBO, Full Time, First Shift

UC Health•Cincinnati, OH

About The Position

This multifaceted position combines administrative work, customer service, and credentialing verification. The Credentialing Specialist II prepares, documents, and completes credentialing data processes, including applications and verifications for Medical and Allied Health staff. The role also compiles provider information, prepares applications, maintains organized files, and keeps provider documents and enrollments current. The position independently manages credentialing and enrollment applications and maintenance cases across multiple payors and systems. It includes provider enrollment updates, hospital affiliation and privileging coordination, Medicare and Medicaid maintenance, and the handling of regulatory requirements and payor correspondence. The Specialist supports providers, payors, internal departments, and other customers, maintains audit-ready records, and contributes to cross-training and departmental projects.

Requirements

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

Nice To Haves

CPCS (Certified Provider Credentialing Specialist).

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 documents 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 information, resolve routine discrepancies, and escalate high-risk or nonstandard barriers.
Coordinate with 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, resolving 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 timely escalation of unresolved risks.
Review and respond to payor notices, directory requests, and incoming 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.