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Credentialing Services Specialist
Dean Dorton. Manage provider credentialing and enrollment processes with Medicare, Medicaid, and commercial payers .
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in provider credentialing and enrollment processes, ensuring compliance with HIPAA and payer-specific regulations while managing multiple projects efficiently. Proficient in utilizing credentialing databases and maintaining accurate provider records to support seamless claim processing.
Highest-signal resume keywords
Provider Credentialing ExperienceIntellisoft ProficiencyCAQH Database ExperienceHIPAA Compliance KnowledgeStrong Organizational Skills
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Provider CredentialingPayer EnrollmentRecord-KeepingEFT SetupCredentialing RequirementsClaim ProcessingHealthcare Payer PortalsCredentialing PlatformsDetail OrientationProblem-Solving
Soft Skills
Strong Communication SkillsCustomer Service SkillsProfessionalismCollaborationDiscretion
Tools & Technologies
IntellisoftCAQHMicrosoft Office SuiteEFT PlatformsPayer-Specific Portals
Industry Keywords
Healthcare ConsultingCredentialing RegulationsProvider Records ManagementMalpractice InsuranceDEA Registration
About the role
Key responsibilities & impact- Manage provider credentialing and enrollment processes with Medicare, Medicaid, and commercial payers
- Initiate payer contracts for new physician practices and monitor revalidations and renewals
- Maintain accurate provider records, including licensure, certifications, malpractice insurance, and DEA registration
- Complete applications and updates in Intellisoft, CAQH, and payer-specific portals
- Track and resolve credentialing-related issues to ensure uninterrupted claim processing and payment
- Research and stay current on credentialing requirements and payer policy changes, sharing updates with clients and team members
- Ensure compliance with federal, state, and payer-specific credentialing regulations
- Communicate proactively and professionally with clients, providers, and payer representatives
- Manage multiple credentialing projects simultaneously while meeting deadlines and maintaining quality
- Demonstrate discretion, professionalism, and adherence to HIPAA and confidentiality standards
- Exhibit strong organizational and problem-solving skills in managing high volumes of detailed information
- Collaborate with internal team members to improve workflows and client satisfaction
- Identify process efficiencies and contribute to team success
- Participate in internal training and development programs
- Contribute to continuous improvement initiatives within the Healthcare Consulting team
- Document best practices and credentialing updates
- Assist in mentoring or cross-training new team members
- Represent Dean Dorton’s values of integrity, collaboration, and client service
Requirements
What you’ll need- Minimum of 2 years of experience in provider credentialing, preferably across multiple payers and specialties
- Experience with Intellisoft and CAQH databases preferred
- Familiarity with EFT setup, payer enrollment, and credentialing requirements across multiple states
- Strong attention to detail, organization, and record-keeping skills
- Ability to manage multiple priorities with accuracy under tight deadlines
- Commitment to confidentiality and compliance with HIPAA regulations
- Strong communication and customer service skills
- Proficiency with Intellisoft and CAQH databases
- Proficiency with Microsoft Office Suite (Excel, Word, Outlook, Teams)
- Experience with payer credentialing and electronic payment systems (EFT platforms)
- Experience with healthcare payer portals and credentialing platforms
Benefits
Comp & perks- Flexible work schedules and environment
- Paid Time Off (PTO)
- Paid family leave, medical leave, and maternity/paternity leave programs
- Retirement benefits, including a best-in-class employer match and automatic profit sharing
- Telemedicine
- Mental health resources
- Wellness program reimbursement