Medical Credentialing Specialist

At Redefine Healthcare, the focus is on providing all patients with the highest quality of care and compassion. The dedicated team includes Neurosurgeons, Interventional Pain Management Specialists, Orthopedists, Psychiatrists, Vascular Surgeons, Physical Therapists, and Chiropractors, specializing in superior continuity of care.

The Credentialing Specialist will oversee credentialing software, provider documentation, and credentialing processes for healthcare providers both within the organization and for payors. Responsibilities include managing initial and re-credentialing applications, verifying provider credentials such as licenses and certifications, maintaining up-to-date credential records, ensuring compliance with accreditation standards and regulations, communicating with licensing boards, liaising with outsourced credentialing teams, assisting with credentialing applications to insurance and managed care organizations, supporting the billing team related to credentialing issues, conducting audits of credentialing files, staying current with credentialing regulations, serving as a contact for providers, collaborating with internal departments for onboarding, providing training on credentialing procedures, preparing detailed reports, and ensuring timely credentialing task completion.

Preferred candidates will have a Bachelor's degree in healthcare administration, business administration, or related field, CPCS certification is preferred, and 2-4 years of experience in credentialing or related healthcare field. Experience with credentialing software such as Medallion is a plus. Ability to handle sensitive information with discretion is required.