Credentialing Specialist
Full Time • Dayton
Benefits:
- Dental insurance
- Health insurance
- Paid time off
- Vision insurance
Position Title: Credentialing Specialist
Department: Revenue Cycle Management (RCM) Reports To: RCM FLSA Status: Exempt
Employment Type: Full-Time Job Level: 7
Wage Type: Hourly
Job Summary
The Credentialing Specialist supports the Revenue Cycle Management department by ensuring that all clinicians and Qualified Mental Health Specialist (QMHS) community partners are properly credentialed with insurance payers and other required entities. This position ensures that accurate and up-to-date credentialing information is maintained to support compliant and efficient billing practices.
The specialist gathers, verifies, and submits credentialing documentation, maintains organized records, and assists with recredentialing processes for the clinic. This role requires strong organizational skills, attention to detail, and a professional approach when handling sensitive information.
Essential Duties and Responsibilities
- Gather required credentialing documentation from clinicians and QMHS partners.
- Prepare and submit credentialing and payer enrollment applications to insurance companies and other relevant organizations.
- Track credentialing and recredentialing progress to ensure timely completion and avoid service or billing interruptions.
- Maintain organized digital and physical records of all credentialing and enrollment materials.
- Store documentation in an accessible and secure format for use by the billing team and RCM leadership.
- Ensure that credentialing records are accurate, current, and compliant with payer requirements.
- Serve as a primary point of contact for internal staff and community partners regarding credentialing status or required documentation.
- Communicate with insurance payers, credentialing entities, and clearinghouses to verify provider participation and resolve enrollment issues.
- Collaborate with the billing and denial management teams to ensure claims are submitted appropriately based on credentialing status.
- Assist the RCM Manager with recredentialing tasks and maintenance of organizational enrollment data.
- Monitor renewal timelines for licenses, certifications, and payer recredentialing requirements.
- Provide administrative support for credentialing audits and related projects.
- Maintain strict confidentiality when handling personal and professional information.
- Follow HIPAA and organizational policies for data protection and document handling.
Qualifications
- Exceptional organizational and recordkeeping skills.
- Strong attention to detail and accuracy in documentation.
- Professional and personable communication style.
- Ability to manage multiple deadlines and priorities simultaneously.
- Proficiency with computers and database or document management systems.
- Understanding of healthcare credentialing and payer enrollment processes.
- Experience handling sensitive or confidential information in a professional setting.
- Strong administrative and organizational skills.
- Ability to work independently and meet time-sensitive goals.
- Prior experience in healthcare credentialing, payer enrollment, or provider relations.
- Familiarity with insurance billing and revenue cycle management functions.
- Experience communicating with payers or credentialing organizations.
Position Impact
The Credentialing Specialist ensures that clinicians and community partners are properly credentialed, enabling timely and accurate claim submission and reimbursement. Accurate credentialing records support the billing and denial management teams in making informed decisions, while proactive recredentialing and tracking prevent service interruptions and compliance risks.
Working Conditions
- Professional office setting; remote or hybrid options may be available based on company policy and payer/facility requirements.
- Monday–Friday, standard business hours
- Frequent handling of confidential provider information; strict adherence to HIPAA and privacy policies.
Physical Requirements
- Primarily seated, extensive computer and phone use.
- Frequent typing, data entry, and document handling.
- Prolonged screen time; ability to read fine details on documents and digital forms.
- Occasional walking, standing, and reaching for files or office supplies.
- Light lifting of files or office materials (up to ~20 lbs).
EEO Statement
Carex is an Equal Opportunity Employer. We do not discriminate based on race, color, religion, sex, national origin, age, disability, or any other protected status.
ADA Compliance
This job description is intended to describe the essential functions of the position. Reasonable accommodation may be made to enable individuals with disabilities to perform these functions
We are an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status, or any other characteristic protected by law.
About Us
Our purpose is to inspire positive change by fostering unity among diverse communities and promoting sustainable solutions. We offer a wide range of services, including individual and group therapy, community reinforcement, self-control management and more. We take a holistic approach to treatment, addressing the needs of the whole person.
Carex offers a number of counseling services for children and young adults to fit their needs. Counseling services can assist with issues such as school challenges, parent-child conflict, marriage or relationship problems, anxiety and stress management, depression, grief, loss, abuse, victimization, substance use disorders involving drugs and/or alcohol and other behavioral health concerns.
Most services are provided on an outreach basis – in client’s homes, schools, or other community settings – to reduce barriers to treatment and provide services in the environment where they are needed.
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