Credentialing Specialist

Ivy Rehab•Philadelphia, PA

About The Position

At Ivy Health, the Credentialing Specialist plays a crucial role in the organization's mission to help enable people to live their lives to the fullest. This position maintains accurate provider records and coordinates provider and payor enrollment and credentialing processes. The role requires knowledge of health plans and state agency credentialing requirements, strong research and data analysis abilities, and the ability to work independently while maintaining confidentiality.

Requirements

High school diploma or GED equivalent.
At least two years of experience in all facets of provider healthcare credentialing, with a focus on Outpatient PT/OT/SP/ABA/Pediatric Rehab.
Computer skills using Microsoft Outlook, Word, Excel, and Access.
Experience using credentialing software and working with a CVO and external vendors.
Excellent oral communication skills and phone presence.
Understanding of quality customer service and relationships with insurance carriers and field operators.
Knowledge of health plans and state agency credentialing requirements.
Ability to work independently with minimal supervision.

Nice To Haves

Certified Provider Credentialing Specialist (CPCS) certification.

Responsibilities

Maintain current and accurate data for all providers.
Complete provider and payor enrollment applications, monitor applications, and follow up as needed.
Maintain copies of current state licenses, malpractice coverage, and other required provider documents.
Maintain provider information in online databases such as NPI and CAQH.
Collect information from providers and coordinate with the CVO to submit credentialing requests.
Research and analyze data.
Track license and certification expirations to ensure timely renewals.
Audit and ensure practice address information is correctly listed with health plans.
Maintain confidentiality of provider information.
Perform other duties as assigned.