Healthcare Credentialing Specialist

Job OpportunityPinnacle Wound Management is a leading wound care provider dedicated to delivering high-quality patient care. We are seeking a detail-oriented Healthcare Credentialing Specialist to join our team. This role is critical in ensuring our healthcare professionals meet all necessary licensing, certification, and regulatory requirements. As a Healthcare Credentialing Specialist, you will be responsible for managing the credentialing and re-credentialing process for all of our physicians and mid-level healthcare providers. You will maintain accurate records, verify professional credentials, and ensure compliance with industry regulations and accreditation standards. If you are a meticulous and organized professional with a passion for healthcare compliance, we want to hear from you! Apply now to join us in ensuring the highest standards of wound care excellence!Key Responsibilities:Maintain accurate and up-to-date provider files, ensuring compliance with all credentialing requirementsComplete and track initial and re-credentialing applications for various health insurance portals, including CAQH, PECOS, NPPES, Navinet, Availity, PaySpan, CMS, and Managed Care OrganizationsAssist new providers with applications for National Provider Identifier (NPI), Medicare, and Medicaid numbersMonitor and update provider CAQH profiles in accordance with CMS and Managed Care Organization guidelinesManage termination of payer enrollments for providers leaving the organizationProvide updated demographic information and supporting documents to external stakeholders, including commercial payers and billing entitiesCollaborate with the Director of Operations to ensure timely credentialing and re-credentialing of all providersTrack and ensure the renewal of state DEA licenses, board certifications, and malpractice insuranceIdentify and resolve potential onboarding issues, offering solutions to streamline the credentialing processMaintain records of all managed care contracts and ensure portal logins remain activeEnsure compliance with relevant accrediting and regulatory agenciesMonitor trends and recommend improvements to credentialing workflowsRequirements:High school diploma or equivalent; credentialing certificate preferredMinimum of 5 years experience in physician credentialing, revenue cycle management, or related fieldKnowledge of credentialing standards and healthcare regulationsProficiency in credentialing software and Microsoft Office SuiteStrong attention to detail, organizational, and problem-solving skillsExcellent written and verbal communication skillsAbility to work independently and manage multiple tasks efficientlyBenefits:401k401k matchingCompetitive payMedical, dental, and vision insurancePaid time offFree parkingNo nights, no weekendsMonday - Friday, 8 hour shift