Insurance Credentialing and Data Specialist
About The Position
The Insurance Credentialing & Data Specialist is responsible for managing provider enrollment and credentialing with commercial insurance carriers, government payers, and other healthcare networks while also serving as the primary resource for revenue cycle data extraction, reporting, and analytics. This position plays a critical role in ensuring providers are properly credentialed and enrolled to support timely reimbursement, while delivering accurate and meaningful reports that support operational and financial decision-making. The ideal candidate is highly organized, detail-oriented, analytical, and proficient in healthcare data systems, credentialing processes, and revenue cycle reporting.
Requirements
- Proficiency with Microsoft Excel, including pivot tables, formulas, filtering, and data analysis.
- Knowledge of Power Query or Power BI.
- Experience working with Medicare, Medicaid, and commercial insurance payers.
- Thorough knowledge of provider credentialing and payer enrollment processes.
- Ability to manage multiple priorities while meeting deadlines.
- Excellent written and verbal communication skills.
- High level of accuracy and attention to detail.
- Ability to work independently while collaborating effectively with cross-functional teams.
Nice To Haves
- Associate degree in Healthcare Administration, Business Administration, Health Information Management, Information Systems, or a related field preferred.
- A combination of education and relevant hospital or healthcare revenue cycle experience may be considered in lieu of a formal degree.
- Experience with healthcare data reporting, analytics, or revenue cycle reporting strongly preferred.
Responsibilities
- Managing provider enrollment and credentialing with commercial insurance carriers, government payers, and other healthcare networks.
- Serving as the primary resource for revenue cycle data extraction, reporting, and analytics.
- Ensuring providers are properly credentialed and enrolled to support timely reimbursement.
- Delivering accurate and meaningful reports that support operational and financial decision-making.
- Extracting, organizing, analyzing, and presenting complex data.
- Managing multiple priorities while meeting deadlines.
- Collaborating effectively with cross-functional teams.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
Associate degree
