Credentialing Specialist
2 days ago
Pittsburgh
The Credentialing & Enrollment Support Specialist provides administrative and operational support for credentialing and enrollment processes within a healthcare or managed care environment. This role is responsible for reviewing and processing credentialing documentation, maintaining accurate provider records, and supporting data entry and document management activities while ensuring compliance with organizational standards and quality requirements. Primary responsibilities include reviewing credentialing and enrollment files for accuracy and completeness, performing data entry and document processing activities, and communicating with providers and internal departments regarding missing or incomplete information. This position plays an important role in supporting efficient provider onboarding, maintaining data integrity, and ensuring timely processing of credentialing activities. Key Responsibilities • Review credentialing and enrollment files for completeness, accuracy, and required documentation., • Perform high-volume data entry and maintain accurate provider and credentialing records within internal systems., • Prepare, scan, image, index, file, and retrieve credentialing and enrollment documents., • Process incoming and outgoing correspondence, including mail, fax, and electronic communications., • Contact providers, medical offices, and internal departments to obtain missing documentation or resolve discrepancies., • Maintain credentialing checklists and track application status updates., • Retrieve and organize medical records and supporting documentation as needed., • Navigate multiple software systems, databases, and websites simultaneously to complete daily tasks., • Create, organize, and maintain electronic folders and desktop files for document storage and retrieval., • Assist with inventory, record maintenance, and document tracking activities., • Verify information for accuracy and escalate discrepancies or issues when appropriate., • Support quality assurance and production goals established by management., • Maintain confidentiality of sensitive healthcare and provider information., • Provide administrative support for departmental projects and operational initiatives., • Perform additional administrative and operational duties as assigned. Minimum Education & Experience Requirements • High School Diploma or GED required., • Associate degree or healthcare-related coursework preferred., • Minimum of 1-3 years of administrative, credentialing, enrollment, healthcare support, or data entry experience required., • Experience working in healthcare, managed care, insurance, medical office, or provider services environments preferred., • Prior credentialing or provider enrollment experience preferred., • Experience handling medical records, provider documentation, or compliance-related files preferred., • Experience working with multiple computer systems and web-based applications required. Special Requirements • Ability to maintain confidentiality and handle sensitive information appropriately., • Strong typing and data entry accuracy skills required., • Ability to meet established productivity and quality standards., • Ability to communicate professionally with providers, medical offices, and internal teams., • May require successful completion of background screening in accordance with organizational policies. Knowledge, Skills, and Abilities • Strong data entry, administrative, and document management skills., • Proficiency with Microsoft Office applications, including Word, Outlook, and Excel., • Ability to navigate multiple software applications, databases, and websites efficiently., • Familiarity with credentialing, enrollment, or healthcare administrative processes preferred., • Strong attention to detail with the ability to identify missing or inaccurate information., • Excellent organizational and time management skills., • Effective verbal and written communication skills., • Ability to prioritize tasks and manage multiple assignments in a fast-paced environment., • Strong problem-solving and follow-up skills., • Ability to work independently and collaboratively within a team environment., • Basic knowledge of medical terminology and provider documentation preferred., • Ability to maintain accurate electronic and paper records. Additional Desired Characteristics • Experience working with provider credentialing systems or enrollment platforms., • Familiarity with healthcare compliance and documentation standards., • Prior experience supporting provider relations or customer service functions., • Strong adaptability and willingness to learn new systems and processes., • Ability to work efficiently in a production-driven environment. Work Environment • Office or hybrid work environment depending on organizational needs., • Role may involve extended periods of computer and data entry work., • Frequent interaction with providers, healthcare offices, and internal departments., • Standard business hours with occasional overtime based on workload or departmental deadlines., • Fast-paced administrative environment with established productivity expectations. Other Duties This job description is not intended to be an exhaustive list of all duties, responsibilities, or qualifications associated with the position. Additional duties and responsibilities may be assigned based on business needs and organizational requirements.