Credentialing Specialist

Job Description

Job DescriptionSalary: $22.50 - $30.50

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About Finger Lakes Community Health:

Finger Lakes Community Health (FLCH) was founded in 1989 with an original mission of serving the region's agricultural workers by linking individuals to area resources and providing essential health services. In 2009 the organization expanded to become a Federally Qualified Health Center (FQHC), serving patients of all incomes, ethnicities, and walks of life. Over the last decade, FLCH has grown to provide medical, dental, and behavioral health services to over 28,000 patients at eight health centers. With over 200 employees we strive to provide high-quality and innovative health care services to the Finger Lakes Region.

BenefitsOffered:

• Monday through Friday schedule, closed all major holidays
• Medical insurance with a 90%+ employer contribution
• Dental, Vision, and Life insurance
• Safe Harbor 3% 401k contribution
• Robust PTO offerings
• Education reimbursement

Job Summary:

The Credentialing Specialist is responsible for managing the credentialing and re-credentialing processes for healthcare providers to ensure compliance with regulatory and payer requirements. This role works within the Finance Department and provides additional administrative support to finance-related functions, including payer enrollment, data management, and financial reporting as needed.

Key Responsibilities:

Credentialing & Re-Credentialing

• Coordinate the credentialing and re-credentialing processes for all healthcare providers, ensuring compliance with federal, state, and payer-specific regulations.
• Maintain accurate and up-to-date provider information in credentialing databases and tracking systems.
• Prepare and submit credentialing applications to insurance payers, hospitals, and other healthcare entities.
• Monitor provider credentialing status and follow up on outstanding applications to prevent disruptions in billing and reimbursement.

Payer Enrollment & Compliance

• Ensure all providers are properly enrolled with Medicare, Medicaid, and commercial insurance payers.
• Track and manage CAQH, NPPES, and PECOS enrollment and updates for providers.
• Work closely with internal departments to ensure provider compliance with credentialing and enrollment requirements.

Support to Finance Department

• Assist in reconciling provider enrollment data with billing and accounts receivable teams to minimize claim denials related to credentialing issues.
• Provide credentialing-related data for financial reporting and audits as required.
• Support financial team operations with administrative tasks such as maintaining documentation, data entry, and reporting.

Communication & Coordination

• Serve as the primary point of contact between providers, payers, and internal departments regarding credentialing matters.
• Keep stakeholders informed on credentialing deadlines, expirations, and outstanding documentation needs.
• Assist providers with credentialing questions and ensure a smooth onboarding process.

Qualifications:

Education

• Associates or Bachelors degree in Business Administration, Healthcare Administration, or a related field preferred.
• Certification in credentialing (e.g., CPCS or CPMSM) is a plus.

Experience

• 2+ years of credentialing experience in a healthcare setting, preferably in a Federally Qualified Health Center (FQHC) or multi-provider environment.
• Experience with insurance payer enrollment processes and credentialing software.
• Familiarity with finance-related administrative tasks is preferred.

Skills & Competencies

• Strong understanding of credentialing, provider enrollment, and compliance requirements.
• Excellent attention to detail and organizational skills.
• Ability to handle sensitive provider information with discretion and confidentiality.
• Strong communication and interpersonal skills for coordinating with providers, payers, and internal teams.
• Proficiency in Microsoft Office Suite and credentialing software systems.

Work Environment:

This role operates in an office environment with a focus on credentialing processes and financial administrative support. Occasional remote work or travel may be required for training or compliance audits.