Senior Credentialing Specialist

Centrum Health•Doral, FL

About The Position

The Senior Credentialing Specialist assists with the day-to-day execution of the provider credentialing process, ensuring providers meet necessary requirements and compliance standards. The role works with providers to obtain required documentation, maintains accurate credentialing records, and supports completion of credentialing in accordance with state, federal, and regulatory guidelines. The position supports the overall credentialing program and collaborates with internal teams and external vendors.

Requirements

High school diploma or GED required.
Three or more years of experience in credentialing, managed care, or a related healthcare field.
Proficiency with Microsoft Office, particularly Excel.
Ability to accurately manage detailed information and ensure compliance with standards and guidelines.
Strong verbal and written communication skills for interacting with providers and internal teams.
Ability to manage multiple tasks and prioritize workloads to meet deadlines.
Ability to work independently and collaborate effectively within cross-functional teams.
Strong analytical skills to assess credentialing issues and take corrective actions where needed.

Nice To Haves

Associate's degree or bachelor's degree in healthcare administration or a related field.
Experience with credentialing software.

Responsibilities

Assist with reviewing and processing credentialing applications, maintaining credentialing files, and tracking application status.
Work with providers to obtain missing documentation or information required for credentialing.
Ensure credentialing activities adhere to company policies, state and federal regulations, and URAC requirements.
Maintain accurate, complete, and up-to-date provider records and credentialing documentation.
Assist in preparing and submitting clean and risk credentialing files for review.
Communicate with providers about application status, gather additional information, and provide guidance on the credentialing process.
Send determination letters based on Credentialing Committee decisions.
Provide administrative support by managing credentialing file feeds, updating credentialing systems, and maintaining provider tools.
Assist in maintaining provider manuals and other credentialing resources.
Collaborate with internal teams and participate in cross-functional initiatives to support smooth credentialing operations.
Perform other related tasks and responsibilities as assigned to support the credentialing program.