• Responsible for specific aspects of Credentialing and Re-credentialing processing for a managed care organization • Adhering to the National Committee for Quality Assurance, State and Federal regulations • Review, investigate, and process primary source verifications for facility, ancillary, medical and behavioral providers in a timely, efficient manner

• The Credentialing Specialist will be responsible for timely submission and follow-up for institutional and individual provider credentialing, contracting, and re-credentialing with health insurance payors across multiple states and service lines. • Assists in verifying and monitoring credentials of healthcare providers and completing facility applications as needed. • Maintains confidential files of providers records to meet company and compliance standards. • Prepare and submit credentialing applications and supporting documentation for the purpose of enrolling groups and providers with Commercial, Medicare, and Medicaid networks. • Follow up on the status of applications for providers with payers, tracking progression of pending and completed work. • Maintains accurate and up-to-date database of information including provider credentials and payer statuses. • Works closely with internal teams to communicate approvals and work through denials as necessary. • Maintains knowledge of current payer requirements across multiple states and service lines. • Maintain strict level of confidentiality and HIPAA compliance. • Familiarity with state licensing requirements and provider onboarding tasks. • Familiarity with various payer portals and CAQH. • Contact providers and payers, by phone or email, for updates and/or to request missing information. • Ensure group and provider information is current/accurate with health insurance payers. • Assist with facility credentialing applications as needed.