Credentialing Specialist
About The Position
Preferred Therapy Partners, a brand partner of Upstream Rehabilitation, is seeking a Credentialing Specialist to support the initial credentialing and recredentialing of practitioners in the Preferred Therapy Providers network. The role involves collecting and verifying practitioner information, conducting primary source verification, maintaining credentialing records, and coordinating with contracted health plans and internal and external stakeholders. The specialist keeps practitioner data accurate and current, monitors licensure and certification requirements, and supports credentialing activities in compliance with applicable regulations, accreditation standards, payer requirements, and company policies. This position contributes to maintaining a high-performing provider network and advancing the organization's mission and growth. The position is remote and designated for Arizona; applicants must reside in the United States.
Requirements
- High school diploma or equivalent experience.
- Strong attention to detail and self-motivation.
- Effective written and verbal communication skills.
- Ability to establish and maintain positive working relationships with providers, leadership, staff, and external partners.
- Proficiency in Microsoft Office applications, including Word and Excel, Adobe Acrobat, and web-based systems.
- Ability to organize and prioritize work, manage multiple responsibilities, and meet deadlines in a fast-paced environment.
Nice To Haves
- Previous experience with healthcare credentialing, provider enrollment, revenue cycle operations, or other healthcare administrative functions.
- Experience supporting healthcare organizations, including physical therapy, rehabilitation, or related clinical settings.
Responsibilities
- Maintain accurate and timely practitioner data, electronic files, and credentialing records in the credentialing database.
- Access and manage practitioner information through CAQH and paper application systems to support credentialing and recredentialing.
- Provide administrative support for credentialing operations.
- Perform primary source verifications and maintain practitioner licensing, credentialing, certification, and insurance records.
- Monitor license, certification, insurance, and continuing education requirements; track expiration and renewal dates; and maintain compliance with applicable standards.
- Communicate with internal stakeholders and external practitioners about application status, credentialing requirements, and outstanding documentation.
- Perform credentialing and recredentialing in accordance with federal and state regulations, payer requirements, accreditation standards, and company policies and procedures.
- Monitor credentialing files and outstanding requirements, identifying and escalating delays, deficiencies, or compliance concerns as appropriate.
- Maintain the confidentiality, integrity, and security of practitioner information and credentialing records.
- Cross-train and provide support in other functional areas as needed.
- Perform other projects and duties as assigned.
Benefits
- Annual paid Charity Day.
- 100% employer-paid medical health insurance premium option.
- Dental and vision insurance.
- 401(k) with company match.
- Generous PTO and paid holidays.
- Supportive team and leadership invested in employee success.
- Ongoing professional development and growth opportunities.
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
High school or GED
