Credentialing Specialist

Ventra Health


Job Summary:

  • The Credentialing Specialist provides credentialing support for several medical practices to include facility credentialing, payer credentialing, and license/certification renewal. The credentialing specialist will also interact closely with the Client Managers of the practices in meeting credentialing needs. Direct interaction with the providers is anticipated. This person will work with the Credentialing team to meet department goals and will report to the Credentialing Manager.


Essential Functions and Tasks:

  • Accurately complete credentialing and reappointment applications to be sent to payers and facilities on behalf of providers
  • Track progress of outstanding applications and report progress to Client Managers/Team Leaders
  • Work effectively in a team environment
  • Keep current provider records electronically in Credentialing software, electronic provider folders, and in provider hard copy folders
  • Assist in obtaining needed documentation from providers, such as copies of state licenses, IRS documents, NPI Notification forms, DEA numbers, board certifications, malpractice certificate of insurance, etc.
  • Prepare professional communication to providers, payers, and facilities
  • Understand how provider credentialing impacts billing, contracts, and EDI
  • Write professional communication to appropriate audience
  • Ability to learn new software OneApp, OmniForm and IntelliSoft
  • Complete tasks and projects by deadline
  • Generate daily reports
  • Investigate solutions to problems and determine best course of action
  • Self-motivated
  • Communicate clearly and professionally with team members, providers, payers, facility credentialing representatives, Client Managers, and Team Leaders
  • Ability to multi task
  • Proficiency in MS Office
  • Ability to prioritize and organize


Education and Experience Requirements:

  • High School diploma or equivalent
  • Minimum 2 years of credentialing experience preferred
  • At least one year in data entry field
  • At least one year in medical billing preferred
  • Willingness to learn

Knowledge, Skills, and Abilities (KSA’s):

  • Basic use of computer, telephone, internet, copier, fax, and scanner
  • Become proficient in use of MedSuite software within 4 weeks
  • Maintain proficiency in use of Medsuite software
  • Touch-typing skills, 40 wpm required, 50 wpm preferred
  • Basic touch 10 key skills
  • Understand and comply with company policies and procedures
  • Basic knowledge of Outlook, Word and Excel