Credentialing Specialist

Carex Behavioral Health Services•Dayton, OH

12d

About The Position

The Credentialing Specialist supports the Revenue Cycle Management department by ensuring that all clinicians and Qualified Mental Health Specialist (QMHS) community partners are properly credentialed with insurance payers and other required entities. This position ensures that accurate and up-to-date credentialing information is maintained to support compliant and efficient billing practices. The specialist gathers, verifies, and submits credentialing documentation, maintains organized records, and assists with recredentialing processes for the clinic. This role requires strong organizational skills, attention to detail, and a professional approach when handling sensitive information.

Requirements

Exceptional organizational and recordkeeping skills.
Strong attention to detail and accuracy in documentation.
Professional and personable communication style.
Ability to manage multiple deadlines and priorities simultaneously.
Proficiency with computers and database or document management systems.
Understanding of healthcare credentialing and payer enrollment processes.
Experience handling sensitive or confidential information in a professional setting.
Strong administrative and organizational skills.
Ability to work independently and meet time-sensitive goals.

Nice To Haves

Prior experience in healthcare credentialing, payer enrollment, or provider relations.
Familiarity with insurance billing and revenue cycle management functions.
Experience communicating with payers or credentialing organizations.

Responsibilities

Gather required credentialing documentation from clinicians and QMHS partners.
Prepare and submit credentialing and payer enrollment applications to insurance companies and other relevant organizations.
Track credentialing and recredentialing progress to ensure timely completion and avoid service or billing interruptions.
Maintain organized digital and physical records of all credentialing and enrollment materials.
Store documentation in an accessible and secure format for use by the billing team and RCM leadership.
Ensure that credentialing records are accurate, current, and compliant with payer requirements.
Serve as a primary point of contact for internal staff and community partners regarding credentialing status or required documentation.
Communicate with insurance payers, credentialing entities, and clearinghouses to verify provider participation and resolve enrollment issues.
Collaborate with the billing and denial management teams to ensure claims are submitted appropriately based on credentialing status.
Assist the RCM Manager with recredentialing tasks and maintenance of organizational enrollment data.
Monitor renewal timelines for licenses, certifications, and payer recredentialing requirements.
Provide administrative support for credentialing audits and related projects.
Maintain strict confidentiality when handling personal and professional information.
Follow HIPAA and organizational policies for data protection and document handling.