H2 Health

Credentialing Specialist

• Coordinate provider and facility credentialing, recredentialing, and enrollment processes with insurance payers, including Medicare, Medicaid, and commercial insurance plans.
• Review credentialing information in Medallion, verifying provider details, credentialing status, and supporting documentation.
• Maintain and update provider profiles in the CAQH system, including required attestations and supporting documentation.
• Assist clinicians with NPI applications and updates.
• Monitor professional licenses, certifications, expiration dates, and other required credentialing documentation.
• Add newly hired providers to applicable insurance payer rosters and remove terminated providers as required.
• Track credentialing applications, renewals, outstanding documentation, and payer enrollment status.
• Communicate with clinicians, insurance representatives, and internal departments to obtain information and resolve credentialing discrepancies.
• Assist clinicians with fingerprinting and other credentialing documentation.
• Maintain confidential, accurate, and organized credentialing records in accordance with applicable regulations and company policies.
• Support additional administrative and compliance-related tasks as needed.

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Credentialing Specialist