Credentialing Specialist

FRIENDSHIP COMMUNITY CARE•Russellville, AR

33d•Onsite

About The Position

Friendship Community Care is seeking a highly organized Credentialing Specialist. The ideal candidate will have experience with healthcare credentialing, provider enrollment, compliance documentation, and license verification in a healthcare, behavioral health, or human services environment. SUMMARY: The Credentialing Specialist will manage provider credentialing, licensure tracking, and payer enrollment for healthcare professionals. This role ensures all licensed providers meet state regulatory, Medicaid, Medicare, and insurance payer requirements prior to delivering services.

Requirements

Associate’s or Bachelor's degree in Healthcare Administration, Business Administration, Human Resources, or related field preferred. Or equivalent combination of education and experience.
1-3 years of healthcare credentialing, provider enrollment, medical staff services, or healthcare administration experience preferred.
Strong organizational, documentation management, and attention to details skills.
Proficiency with Microsoft Office and credentialing or HR systems.
Ability to read, analyze, and interpret general business periodicals, professional journals, technical procedures, or governmental relations.
Ability to write reports, business correspondence, and procedure manuals.
Ability to effectively present information and respond to questions from groups of employees and managers.
Ability to calculate figures and amounts such as discounts, interest, commissions, proportions, percentages, area, circumference, and volume.
Extensive knowledge of computer software including Window Word, Excel, PowerPoint.
Ability to apply commonsense understanding to carry out instructions furnished in written, oral, or diagram form.
Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form.
Ability to apply commonsense understanding to carry out instructions furnished in written, oral, or diagram form.
Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form.
The employee must occasionally lift and/or move up to 50 pounds.
Specific vision abilities required by this job include close vision, color vision, depth perception, peripheral vision, and the ability to adjust focus.

Nice To Haves

Experience using credentialing software such as Modio.
Experience working in behavioral health, developmental disability services, or healthcare organizations.
Familiarity with state licensing boards and regulatory compliance requirements.

Responsibilities

Manage provider credentialing and recredentialing for licensed staff including therapists, nurses, and other healthcare providers.
Coordinate payer enrollment and provider applications with Medicaid, Medicare, and commercial insurance companies.
Perform primary source verification for professional licenses, certifications, education, and training.
Track and monitor license expirations, certifications, background checks, and credential renewals.
Maintain accurate provider files in credentialing databases and internal systems.
Prepare and submit credentialing applications, revalidations, and updates to payers and regulatory agencies.
Work with HR and program leadership to ensure providers are fully credentialed prior to service delivery.
Maintain compliance with state licensing boards, healthcare regulations, and payer requirements.
Assist with audits, compliance reviews, and accreditation documentation.
Communicate with providers to collect required documentation and resolve credentialing issues.
Maintains confidentiality of all information received regarding Friendship Community Care, Inc. and the clients.
Consumers’ progress notes be maintained and completed daily or as needed on the prescribed forms.
Consumers’ records must be maintained weekly, monthly, quarterly, and yearly.
All information must be filed in consumers’ records as needed and updated as prescribed by funding sources.