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Credentialing Specialist

The Credentialing Specialist is a well-organized, positive, professional responsible for credentialing and re-credentialing FQHC providers for each client assigned to them.  The Credentialing Specialist will routinely interact with the client and Synergy billing operations in support of credentialing needs that arise and address any concerns identified in weekly meetings.

Supervisor: Reports directly to the Credentialing Manager.

Essential Functions: 

  • Oversight of the credentialing activities for the client account, including but not limited to credentialing and re-credentialing of all providers.

  • Complete and submit initial credentialing applications (CAQH, payer portals, paper apps)

    Enroll providers with commercial insurers, Medicare, and Medicaid

  • Track application status and follow up with payers

  • Maintain and update CAQH profiles (attestations, documents, re-attest every 120 days)

  • Monitor and complete recredentialing cycles

  • Update provider info (address, tax ID, group affiliations, specialties) and handle payer roster updates (adds/terms/changes)

  • Clear, constant communication with clients and payers to address and resolve any questions or concerns.

  • Payer communication as needed.

  • Collaborate with revenue cycle managers and team members on credentialing needs.

  • Attend weekly meetings with client and management.

  • Maintain strict confidentiality and adhere to all HIPAA guidelines/regulations.

  • Ensure commitments to clients are met.

Education: High School Diploma or GED required. Credentialing certificate preferred, at least (1) one to (2) two years of previous credentialing experience or demonstrated mastery in Credentialing Associate role at Synergy required.

Skills/Experience:

  1. At least (1) one to (2) two years of credentialing experience.
  2. A background in FQHC and/or medical facility preferred.
  3. Knowledge of medical insurance credentialing practices.
  4. Knowledge of insurance credentialing forms in accordance with the CAQH.  
  5. Knowledge of business office procedures.
  6. Comprehensive understanding of how to process paper and electronic credentialing forms.
  7. Ability to operate a computer and basic office equipment.
  8. Ability to operate a multi-line telephone system.
  9. Intermediate skill using Microsoft Office suite.
  10. Ability to establish and maintain effective working relationships with insurance company representatives, colleagues, clients, and patients if needed.
  11. Excellent verbal and written communication skills.

Environmental/Working Conditions: Requires sitting and standing associated with a normal office/classroom environment. 

Manual dexterity is needed for using a calculator and computer keyboard. Occasional classroom environment and over-time may be required and/or hours may be shortened as business needs dictate.

This description is intended to provide only basic guidelines for meeting job requirements. Responsibilities, skills, and working conditions may change as needs evolve.

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