Credentialing Specialist

About the Role

Reviews, analyzes, evaluates, and validates provider/producer information against business/credentialing requirements. Maintains information on Credentialing databases. Supports extensive research and analysis of sensitive provider/producer issues and addresses data integrity issues.

Key Responsibilities

• Assist with reviewing, analyzing, and validating provider/producer information to ensure it meets credentialing and business requirements.
• Maintain and update provider/producer records in credentialing databases with a high level of accuracy.
• Support research and review of provider/producer information, escalating sensitive or complex issues as needed.
• Help identify and correct data discrepancies to support overall data integrity and compliance.
• Handle confidential and sensitive information with professionalism, discretion, and care.
• Organize and prioritize assigned tasks to meet deadlines in a fast-paced environment.
• Draft and respond to basic professional correspondence, including emails and routine notices.
• Communicate effectively with providers, internal staff, and management under guidance and supervision.
• Work independently on routine tasks while seeking guidance for new or complex issues.

Requirements & Tech Stack

• Use Microsoft Office applications (Word, Excel, Access) and internet resources to research and maintain information.
• Demonstrate strong attention to detail.
• Willingness to learn credentialing policies, procedures, and systems.
• Able to work the Franklin Hybrid work model, 3 days in office.

Qualifications

• High School diploma.
• 1+ years customer service experience.
• 6+ months experience researching and analyzing data.
• 6+ months experience working with Microsoft Office applications (Word, Excel, Access) and internet resources.
• Ability to work independently on routine tasks.
• Ability to work reliably, prudently, and tactfully with confidential information.
• Ability to organize and prioritize work and manage multiple priorities.
• Excellent verbal and written communication skills including, letters, memos, and emails.
• Ability to establish and maintain effective working relationships with providers, management, staff, and contacts outside the organization.
• Associate's degree preferred.