Credentialing Specialist

RURAL HEALTH CARE INC dba Aza Health • Palatka, FL

24d

About The Position

The Credentialing Specialist is responsible for assisting with the credentialing and privileging process for the provider staff; for preparing and processing enrollment applications for provider participation in health insurance (payor) plans; for assisting in the preparation of materials for Provider and Credentials meetings; and, for providing staff assistance to the Provider Staff Liaison on difficult/complex projects and programs pertaining to clinical operations. This position reports to the Provider Staff Liaison and has no supervisory responsibilities.

Responsibilities

• Assists with the preparation and processing of initial and reappointment credentialing applications for clinical providers.
• Maintains credentialing files, ensuring all documentation is current, complete, and compliant with applicable standards.
• Tracks expiration dates for licenses, certifications, and other required credentials and notifies appropriate parties of upcoming renewals.
• Supports data entry and record maintenance within credentialing systems and files.
• Assists in preparing enrollment applications for provider participation in health insurance (payor) plans.
• Gathers required documentation and follows up on outstanding items for timely submission.
• Tracks application statuses and communicates updates to the Provider Staff Liaison.
• Assists with re-credentialing requests and documentation collection.
• Assists with coordinating provider PTO and CME requests, ensuring appropriate documentation and approvals are obtained.
• Supports the preparation of monthly provider schedules to help ensure adequate staffing coverage across all centers.
• Assists in tracking provider availability, call schedules, and coverage needs.
• Assists in maintaining credentialing and privileging records in accordance with AAAHC standards, Bureau of Primary Health Care policies, and state/federal regulations.
• Help prepare reports, spreadsheets, and supporting documentation for audits, surveys, and internal reviews.
• Provides administrative support for policy updates, forms, and process improvements as directed.
• Maintains confidentiality of all provider and organizational information.
• Provides administrative support on special projects related to provider staffing operations.
• Communicates professionally with providers, staff, and external entities as needed.
• Performs other duties as assigned.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: No Education Listed