CREDENTIALING ASSISTANT

We are seeking a detail-oriented and organized Credentialing Assistant to join our team. In this role, you will be responsible for the primary-source verification of our healthcare providers' licenses, education, and professional history. You will ensure full compliance with federal, state, and insurance regulations, keeping our provider data current to prevent any disruptions in patient care or billing.

 

Responsibilities:

· New hire set-up LM’s and LC’s procedure. Completing applications

· Complete and submit LC’s initial credentialing and re-credentialing applications to insurance payers, Medicare, and Medicaid.

· Verify licenses, educational backgrounds through official databases.

· Monitor expiration dates for all provider credentials and malpractice insurance, ensuring timely renewals.

· Investigate and resolve enrollment delays, missing data, or application rejections with payers.

· Administrative Insurance contracts and notices

· Insurance contracts, issues, notices, and requests

· Insurance companies’ attestation, updates, changes

· CAQH Registration LC’s updates & uploads data and information

· Terminations – notify insurance companies.

 

All other duties as assigned by the manager/supervisor

 

Skills:

· 1–3+ years of direct experience in medical credentialing, provider enrollment, or healthcare compliance.

· Proficient in credentialing and CAQH. Exceptional attention to detail and strong data entry accuracy.

 

Education:

· Bachelor’s or Associate degree in healthcare administration, business, or a related field.