Credentialing Specialist

About This Role

This Credentialing Specialist role is essential for ensuring that providers at the State Hospital and Behavioral Health Clinic are properly credentialed with insurance companies, which supports accurate and timely reimbursement. The specialist manages all aspects of provider credentialing, recredentialing, and updates, working closely with various teams to resolve billing and reimbursement issues. This position is crucial for maintaining organizational revenue integrity and upholding high standards of accuracy and compliance.

Responsibilities

• Ensure billable State Hospital and Behavioral Health Clinic providers are appropriately credentialed and in-network with contracted insurance companies
• Manage provider credentialing, recredentialing, updates, and provider corrections
• Collaborate closely with clinical, support, and revenue cycle teams to resolve issues that impact billing and reimbursement
• Ensure all provider credentials remain active and fully up to date within the electronic health record (EHR)
• Track license renewals, credentials, taxonomies, and provider terminations
• Maintain and manage provider rosters across various insurance payer portals
• Submit timely updates and process provider changes including name, location, role, and credential adjustments
• Process and complete requests from providers regarding edits to their clinical notes, service information, and encounter details within the EHR
• Perform Admission, Discharge, and Transfer (A/D/T) corrections in the EHR
• Resolve discrepancies involving patient movement, service dates, and provider attribution
• Work closely with other team members, clinical staff, and administrative personnel to complete tasks and clarify data errors
• Track recurring trend patterns for leadership
• Maintain positive, collaborative working relationships across departments

Requirements

• High school diploma or GED
• At least 5 years of experience working in a healthcare or human services environment, including healthcare administration, clinical support, medical records, billing, insurance, patient access, or other healthcare support functions

Nice to have:

• Experience working with electronic health records (EHRs) or other healthcare information systems
• Demonstrated experience managing provider rosters and payer portals
• Experience reviewing and maintaining detailed documentation for accuracy and completeness
• Strong communication and collaboration skills with clinical staff, support staff, providers, and interdisciplinary teams

Benefits

• Strong and competitive rewards package

Application Process