Provider Credentialing Specialist

Summary

Join Upstream Rehabilitation as a Provider Enrollment Credentialing Specialist! You will be responsible for the credentialing and re-credentialing of all medical providers and groups. Maintain accurate provider data in databases and online systems, ensuring timely license and certification renewals. Collaborate with internal teams and external payers. This role requires attention to detail, strong communication skills, and proficiency in Microsoft Office applications. Upstream offers a comprehensive benefits package including paid time off, health insurance, and a 401k match.

Requirements

• High school diploma or equivalent experience
• Prior experience in Medical Credentialing Process and Revenue cycle
• Attention to detail, self-motivated and the ability to communicate effectively
• Ability to establish and maintain effective working relationships with providers, management, staff, and contacts outside the organization
• Proficient use of Microsoft Office applications (Word, Excel, Adobe) and internet resources
• Ability to organize and prioritize work and manage multiple priorities and deadlins

Responsibilities

• Maintain timely and accurate data entry and periodically revise practitioner data in the credentialing database OneApp
• Maintain practitioner paper and electronic data files for practitioners
• Use the CAQH system to submit practitioner data as required by some client health plans to credential individual practitioners
• Initial setup and/or maintenance of approved participating online payer systems
• Completes provider credentialing and re-credentialing applications
• Monitors applications and follows-up as needed to ensure enrollment with contracted health plans
• Maintains copies of current state licenses and any other required credentialing documents for all assigned providers
• Collaborate with HR to facilitate onboarding for all practitioners
• Communicate with field & therapist during the credentialing process and respond to field inquires in relation to credentialing request
• Communicate with payers for necessary updates and processes
• Uphold Federal & State regulations in regards to credentialing & licensing of clinicians’ agencies
• This position may cross-train to perform tasks from other positions

Benefits

• Annual paid Charity Day to give back to a cause meaningful to you
• Medical, Dental, Vision, Life, Short-Term and Long-Term Disability Insurance
• 3-week Paid Time Off plus paid holidays
• 401K + company match