Senior Credentialing Specialist

The role

The Senior Credentialing Representative assists with the day-to-day execution of the provider credentialing process. This role involves working with providers to obtain documentation and maintaining records in accordance with regulatory guidelines.

What you will do

• Review and process credentialing applications
• Maintain credentialing files and track application status
• Work with providers to obtain missing documentation
• Ensure activities adhere to company policies, state and federal regulations, and URAC requirements
• Maintain up-to-date records and documentation for all providers
• Prepare and submit credentialing files for review
• Communicate with providers regarding application status
• Send out determination letters based on Credentialing Committee decisions
• Provide administrative support by managing file feeds and updating systems
• Assist in maintaining provider manuals and credentialing resources

Required qualifications

• High School diploma or GED
• Three (3) or more years of experience in credentialing, managed care, or a related healthcare field
• Proficiency with Microsoft Office, particularly Excel
• Ability to manage detailed information accurately and ensure compliance
• Strong verbal and written communication skills
• Ability to manage multiple tasks and prioritize workloads
• Ability to work independently and collaboratively
• Strong analytical skills

Nice to have

• Associate's degree or Bachelor’s degree in healthcare administration or related field
• Experience with credentialing software

About the company

NeueHealth is a value-driven healthcare company that delivers clinical care through owned clinics like Centrum Health and Premier Medical. They aim to make healthcare accessible and affordable across the ACA Marketplace, Medicare, and Medicaid.