Contracting Credential Specialist

BrightSpring Health Services

Do you have a passion for establishing partnerships and strategies in achieving organizational excellence? Our Business Development & Sales teams focus on developing strategic solutions to align and grow the business. Continue reading for information regarding this position and apply today!

The Credentialing Assistant is responsible for the processing of initial credentialing, privileging, re-credentialing and re-privileging applications of health care providers, as well as processing provider enrollment applications and supporting documentation for payer enrollment and re-enrollment. The position maintains the provider files and reports, status of applications and pertinent licenses and certifications. He/she has knowledge of commonly used credentialing concepts, practices and procedures to perform the functions of the job and must be detail oriented and thorough in order to ensure the complex enrollment packages are complete and correct. Communication with providers and others within the organization is essential.
• Work with providers in person, by phone, fax, mail or email to obtain provider credentialing and insurance enrollment forms and all supporting documentation
• Maintain current and accurate data needed for the credentialing and re-credentialing process for all providers
• Conduct thorough background investigation, research and primary and secondary source verification of all components of the application file per regulatory requirements
• Identify issues requiring additional investigation and evaluation; validate discrepancies and ensure appropriate follow up
• Maintain copies of current state licenses and any other required credentialing documents for all providers
• Respond to inquiries from other healthcare organizations regarding credentialing and privileging issues as they arise
• Follow up with providers to ensure that all necessary information is received and that the enrollment process is completed timely
• Maintain up-to-date documentation and insurance files with applications, acceptance letters, provider numbers and completed provider enrollments
• Retain detailed and accurate lists of insurance plans in which providers participate and their effective dates with each plan
• Re-credential providers as required by individual insurance plans
• Perform other duties as assigned

• Associates Degree in business or health related field preferred
• Three years Credentialing and Provider Enrollment experience preferred
• Must be an organized "self-starter" requiring little supervision in order to focus on and accomplish tasks
• Professional written and verbal communication and interpersonal skills required
• Ability to maintain complete confidentiality in handling sensitive enrollment issues
• Ability to prioritize and multitask in a fast-paced environment
• Strong attention to detail required
• Proficiency in Microsoft Office, particularly Excel, Word, and Outlook
• Database management skills including querying reporting and documentation generation
• Knowledge of Medicaid and Commercial Payer Provider Enrollment preferred