Credentialing Specialist

Position: Credentialing Specialist

Job Summary: Credentialing Specialist will ensure that all credentialed staff members meet the necessary qualifications and maintain compliance with regulatory and organizational standards. This role is responsible for verifying education and employment history, confirming certifications and licenses, tracking expirations and renewals, and supporting both internal and outsourced credentialing processes. Experience in behavioral health and a working knowledge of the revenue cycle are highly valued. This position reports to the Director of Revenue Cycle Management.

Duties and Responsibilities:

Duties include, but are not limited to:

• Maintain compliance with all regulatory, licensing, and accrediting requirements.
• Ensure accuracy of all provider credentialing information.
• Guide staff through the license and credential renewal process.
• Maintain organized and up-to-date records of licenses, credentials, and insurance contracts.
• Collaborate with the Revenue Cycle Manager to resolve issues related to denials or authorizations tied to credentialing.
• Partner with the Accounts Receivable (A/R) team to address and resolve credentialing-related concerns.
• Accurately complete and review provider applications and documents.
• Communicate and follow up with all new hires to ensure they have submitted all required credentialing documents prior to their start date.
• Track and notify currently credentialed staff of upcoming expirations and take necessary actions to ensure they remain in full compliance.
• Other duties as assigned.

Required Experience/Certifications:

• High School Diploma or GED equivalent required.
• Minimum of two (2) years of provider credentialing experience with payors.
• Proficiency in completing and reviewing credentialing applications and documents with attention to detail
• Must pass BCI check, all Corporate Compliance checks, and employment drug screen.

Desired Experience/Certifications:

• Working knowledge of the revenue cycle and its connection to provider credentialing.
• Experience with Medicaid credentialing processes.
• Experience in behavioral health credentialing

Compensation: $20.53 - $27.36

Schedule: Monday - Friday 8:30a-5pm

Location: 140 E Town St Columbus, OH 43215