Credentialing Support Specialist

Platinum Dermatology Partners LLC•Dallas, TX

9d•Onsite

About The Position

Reporting to the VP of Clinical Integrations & Shared Services, the Credentialing Specialist is responsible for managing all aspects of provider credentialing, recredentialing, payer enrollment, and privileging within an assigned region. This role partners closely with operational leaders to ensure proactive communication regarding credentialing requirements, enrollment timeframes, and provider onboarding activities. The Credentialing Specialist helps ensure timely provider activation and uninterrupted participation with contracted health plans.

Requirements

High school diploma or equivalent required.
Minimum of three (3) years of experience in provider credentialing, payer enrollment, medical staff services, or related healthcare administration required.
Strong knowledge of California Payers.
Proficient in Microsoft Office Suite, including Excel, Word, Outlook, and Teams.
Ability to handle confidential information with discretion and professionalism.

Nice To Haves

Associate or bachelor’s degree preferred.
Experience supporting multi-site physician practices or healthcare organizations preferred.
Strong knowledge of provider credentialing, recredentialing, and payer enrollment processes.
Working knowledge of commercial, Medicare, Medicaid, and managed care payer requirements.
Experience utilizing CAQH, PECOS, Modio, and payer portals.
Familiarity with credentialing standards established by NCQA, CMS, and other regulatory agencies.
Excellent organizational and project management skills with the ability to manage multiple priorities and deadlines.
Strong attention to detail and commitment to data accuracy.
Excellent verbal and written communication skills.
Strong problem-solving and analytical abilities, including the capacity to independently research and resolve issues.
Ability to work collaboratively across departments while maintaining a high level of customer service.

Responsibilities

Manage all aspects of provider credentialing, recredentialing, payer enrollment, and privileging activities for assigned providers and regions.
Coordinate enrollment and credentialing processes with contracted commercial, government, and managed care payers.
Ensure compliance with all payers, regulatory, accreditation, and organizational credentialing requirements.
Participate in regular meetings with assigned regional leaders to review onboarding status, pending applications, and enrollment needs.
Compile, maintain, and audit provider credentialing files to ensure all records are complete, accurate, and current.
Prepare, submit, and monitor credentialing, recredentialing, and payer enrollment applications through completion and approval.
Maintain current copies of provider licenses, DEA registrations, board certifications, malpractice insurance certificates, and other required credentials.
Track expiration dates for licenses, certifications, registrations, and other credentials to ensure timely renewals and uninterrupted payer participation.
Maintain accurate provider information within credentialing software (Modio), CAQH, PECOS, payer portals, and other applicable databases.
Audit payer directories and provider listings to ensure provider information is accurate and up to date.
Process provider demographic updates, including practice locations, billing information and other required updates.
Identify opportunities to improve credentialing workflows and implement standardized best practices.
Participate in quality improvement initiatives related to credentialing operations, payer enrollment, and data integrity.
Maintain strict confidentiality of provider, patient, and organizational information.
Perform additional duties and special projects as assigned.