Credentialing Specialist

Essential Function and Responsibilities:

• Add, update and maintain accurate provider information in CAQH, CredentialStream and other tools commonly utilized for credentialing and payer enrollment


• Work closely with providers, internal departments and other team members to obtain necessary information for timely onboarding


• Complete, submit, document and pro-actively track and follow-up on required credentialing, enrollment and re-credentialing applications, paying close attention to details


• Gather, compile and continuously monitor information necessary for enrollment and credentialing purposes


• Update and inform department and other leadership of progress and issues using various means of communication


• Research and respond to internal and external inquiries related to enrollment and credentialing issues

• Maintain working knowledge of applicable regulations, policies and procedures and understand specific application requirements for both facility credentialing applications and payer enrollment submission


• Work collaboratively in a team environment to achieve team and organizational goals by sharing information and resources


• May assist other team members with the provider licensing and renewal process


• Maintain a high level of confidentiality regarding legal matters, privacy issues and data integrity


• Miscellaneous job-related duties as assigned

Essential Qualifications

Education: Bachelor's degree, additional experience in lieu of education is accepted.

Experience: 3-5 years of experience in a medical service profession, payer enrollment, insurance plan, revenue cycle, or a combination.

Knowledge/Skills/Experience

• Must be accountable, organized and work independently to self-manage assignments


• Knowledge and understanding of the credentialing process; ability to apply principles, procedures, requirements, regulations and policies


• Effective communication and interpersonal skills for collaboration with internal teams and external stakeholders


• Familiarity with CAQH, Availity, PECOS, NPPES and other common credentialing and payer enrollment tools


• Thrive in a fast-paced, dynamic organization with the ability to work with and prioritize multiple assignments and deadlines while adapting to change as priorities shift


• Express thoughts and information clearly, concisely and effectively both verbally and in writing


• Critical thinker, anticipating next steps


• CPCS certified a plus


• Experience with CredentialStream preferred


• Computer Proficiency, Microsoft Office to include Word, Excel, Power Point

PRISM Vision Group is an Equal Opportunity / Affirmative Action employer.  Candidates are selected solely on the basis of legally permissible job-related criteria without regard to race, color, religion, sex, national origin, disability, marital status, or sexual orientation, in accordance with federal and state law.