This Credentialing Specialist role involves managing all aspects of provider credentialing and recredentialing for 17 surgeons across various surgical specialties. The position requires ensuring accuracy, efficiency, and proactive management of credentialing files, maintaining professional licenses, certifications, and insurance payer enrollment. It suits an organized individual with strong interpersonal skills who can work effectively under time constraints and meet deadlines.
Responsibilities
Manage initial credentialing and ongoing recredentialing for 17 surgeons across multiple specialties
Ensure all details required to complete provider credentialing files are accomplished accurately, efficiently, and proactively
Prepare, submit, track, and follow up on credentialing applications with hospitals, surgical facilities, and insurance companies
Maintain current provider documentation, including medical licenses, DEA registrations, board certifications, malpractice insurance, and other required credentials
Monitor expiration dates and initiate renewal processes well in advance of deadlines
Maintain and update provider CAQH profiles, including required attestations
Verify provider credentials through appropriate primary sources when required
Identify and resolve missing documentation, discrepancies, and application delays
Coordinate initial appointments, reappointments, and privilege renewals at hospitals and surgical facilities
Maintain accurate records of each surgeon's approved hospital and facility privileges
Work closely with medical staff offices to ensure timely completion of credentialing requirements
Track deadlines and proactively address outstanding items to prevent interruptions in privileges
Maintain excellent working relationships with local hospitals, healthcare facilities, and their credentialing personnel
Understand and follow the unique credentialing processes and requirements of each facility
Manage provider enrollment, credentialing, and recredentialing with commercial insurance plans, Medicare, Medicaid, and other applicable payer networks
Maintain professional relationships with insurance companies at both local and national levels
Understand and follow the specific credentialing requirements, application procedures, and deadlines established by individual insurance companies
Complete provider additions, terminations, demographic changes, and practice location updates
Maintain accurate provider information, including NPIs, Tax IDs, addresses, and other required identifiers
Track applications and communicate regularly with insurance representatives to resolve delays and outstanding requirements
Coordinate with billing and administrative personnel to minimize disruptions to payer participation and reimbursement
Millions of jobs, with real people getting hired every day
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1,000,000+
Tailored applications submitted
Maintain a comprehensive and accurate credentialing tracking system
Organize provider files, applications, correspondence, expiration dates, and renewal schedules
Prioritize multiple projects and deadlines simultaneously
Anticipate upcoming credentialing requirements and take necessary action without waiting for reminders
Demonstrate the ability to work efficiently under time constraints while maintaining accuracy
Ensure all applications and supporting documents are submitted within required timeframes
Maintain confidentiality of provider and organizational information
Ensure compliance with applicable credentialing policies, payer requirements, and regulatory standards
Identify potential credentialing or compliance issues and notify management promptly
Establish and maintain excellent working relationships with surgeons, hospital medical staff offices, surgical facilities, and insurance representatives
Communicate professionally, courteously, and effectively with internal and external contacts
Serve as the primary point of contact for credentialing-related questions and requests
Obtain necessary information, documentation, and signatures from providers promptly
Follow up consistently with facilities and insurance companies to ensure completion of credentialing processes
Provide management with updates regarding application statuses, upcoming deadlines, and potential issues
Work collaboratively with administrative, billing, and clinical personnel
Demonstrate proficiency in database management, spreadsheets, Internet research and navigation, Microsoft Word, and Microsoft Excel
Maintain electronic credentialing records, databases, and tracking spreadsheets
Prepare and maintain accurate correspondence, reports, applications, and documentation
Organize digital files and ensure information is readily accessible and current
Learn and effectively use additional software programs and online systems as required
Requirements
Excellent organizational skills with exceptional attention to detail
Strong interpersonal skills and the ability to establish and maintain positive professional relationships
Demonstrated ability to work well under time constraints, manage competing priorities, and consistently meet deadlines
Proficiency in database management, spreadsheets, Internet applications, Microsoft Word, and Microsoft Excel
Excellent written and verbal communication skills
Ability to independently manage multiple detailed processes from beginning to completion
Strong follow-through, problem-solving abilities, and personal accountability
Ability to maintain confidentiality and exercise sound judgment
Ability to work independently with minimal supervision while contributing to a team environment
Previous experience in healthcare credentialing, provider enrollment, or medical administration preferred
Nice to have:
Experience credentialing physicians in a multi-provider surgical practice
Familiarity with general surgery, plastic surgery, and orthopaedic surgery
Experience working with local hospitals, surgical facilities, and nationwide insurance companies
Knowledge of CAQH, Medicare PECOS, Medicaid enrollment systems, and payer credentialing portals
Understanding of applicable credentialing and regulatory requirements
Certified Provider Credentialing Specialist (CPCS) or Certified Professional Medical Services Management (CPMSM) certification
Benefits
Health insurance
Dental insurance
Vision insurance
Pension plan
PTO
Important Details
Schedule: Monday–Friday, 8:30 AM–5:00 PM
About the Company
Utah Surgical Associates employs 17 surgeons practicing in general surgery, plastic surgery, orthopaedic surgery, and other surgical specialties. Its mission is to alleviate suffering through cutting-edge, compassionate surgical care.