Credentialing Specialist II, PBO, Full Time, First Shift

This is a multi-faceted position encompassing elements of administrative tasks, customer service, and credentialing verifications. Prepares, documents, and completes credentialing data processes including applications and verifications for Medical and Allied Health staff. Performs administrative tasks, such as compiling data from providers, preparing applications, maintaining clean and organized files, and maintaining current documents and enrollments for providers.

Independent Credentialing Application and Case Management

• Independently manages credentialing and enrollment applications from receipt through completion for Medical and Allied Health staff across multiple payors.
• Collects, validates, and analyzes provider information and supporting documentation to determine completeness and compliance with established requirements.
• Completes paper and electronic applications, CAQH and Cactus updates, spreadsheets, and payor portal submissions with minimal supervision.
• Monitors application status, responds to requests for additional information, resolves routine discrepancies, and escalates high-risk or nonstandard barriers.
• Coordinates activity across providers, internal departments, payors, and external entities to meet enrollment and maintenance deadlines.

Complex Enrollment Maintenance and Multi-Payor Coordination

• Independently processes provider terminations, practice location additions, changes, and terminations across multiple payors and systems.
• Maintains provider/payor participation (PAR), taxonomy, specialty, demographic, name, licensure, DEA, malpractice, and related enrollment records, resolving routine cross-system discrepancies.
• Coordinates hospital affiliation and privileging activities, including initial appointments, reappointments, and required maintenance documentation.
• Manages assigned maintenance cases end to end, including status tracking, documentation, follow-up, issue resolution, and timely escalation of unresolved risks.
• Reviews and responds to payor notices, directory requests, and incoming correspondence requiring interpretation, coordination, or multi-step follow-up.

Medicare, Medicaid, and Regulatory Maintenance

• Independently completes state-specific Medicare and Medicaid enrollment maintenance, revalidations, recertifications, and related updates according to program requirements.
• Interprets routine regulatory and payor requirements, maintains supporting records, and coordinates corrections when submissions or provider records do not meet requirements.

Training and Cross-Functional Support

• Maintains proficiency across assigned workflows, participates in cross-training, and shares process knowledge with team members.
• Provides practical guidance on established procedures and supports coverage for multiple maintenance functions.

Customer Service

• Provides timely, accurate, and professional support to providers, payors, internal departments, and other customers.
• Anticipates follow-up needs, communicates status clearly, and resolves routine service issues within established authority.

File Maintenance and Department Support

• Maintains complete, accurate, confidential, and audit-ready electronic and paper records.
• Participates in data cleanup, operational projects, correspondence coverage, and other assigned departmental duties.

Minimum Required: High School diploma or GED . | CPCS (Certified Provider Credentialing Specialist) preferred. | 4-8 years of credentialing experience in hospital, physician office, or managed care.

At UC Health, we're proud to have the best and brightest teams and clinicians collaborating toward our common purpose: to advance healing and reduce suffering.

As the region's adult academic health system, we strive for innovation and provide world-class care for not only our community, but patients from all over the world. Join our team and you'll be able to develop your skills, grow your career, build relationships with your peers and patients, and help us be a source of hope for our friends and neighbors.

UC Health is EEO employer.