Process Specialist - Credentialing

Responsibilities

• Conduct Primary Source Verification by contacting licensing boards, educational institutions, and other relevant entities.
• Responsible for data entry and maintaining provider information in online credentialing databases and systems (e.g., CAQH, DEA, Provider Profiles).
• Verify the accuracy and validity of provider credentials, licenses, and certificates.
• Ensure compliance with federal, state, and organizational credentialing requirements.
• Maintain accurate and up-to-date provider profiles in the credentialing department.
• Track and monitor credential expiration dates and recredentialing timelines.
• Initiate and manage the recredentialing process for healthcare providers.
• Ensure providers meet ongoing credentialing requirements.
• Maintain accurate and organized records of credentialing activities.
• Address credentialing inquiries and emails and resolve issues promptly.
• Familiarity with CAQH, license validation, 24 / 7 coverage, attestation dates, specialty verification, DEA, and other external websites related to credentialing.
• Collect and review initial credentialing applications and supporting documentation.
• Monitor development process and follow up with providers as needed until confirmation of in-network status is received.
• Maintain copies of current state licenses, DEA certificates, malpractice coverage, and other required credentialing documents for all providers.

Skills Required

credentialing, Data Entry