Job Summary: The Insurance Credentialing & Data Specialist is responsible for managing provider enrollment and credentialing with commercial insurance carriers, government payers, and other healthcare networks while also serving as the primary resource for revenue cycle data extraction, reporting, and analytics. This position plays a critical role in ensuring providers are properly credentialed and enrolled to support timely reimbursement, while delivering accurate and meaningful reports that support operational and financial decision-making.
The ideal candidate is highly organized, detail-oriented, analytical, and proficient in healthcare data systems, credentialing processes, and revenue cycle reporting.
Knowledge, Skills And Abilities Required
Proficiency with Microsoft Excel, including pivot tables, formulas, filtering, and data analysis. Knowledge of Power Query or Power BI.
Qualifications
- Associate degree in Healthcare Administration, Business Administration, Health Information Management, Information Systems, or a related field preferred.
- A combination of education and relevant hospital or healthcare revenue cycle experience may be considered in lieu of a formal degree.
- Experience with healthcare data reporting, analytics, or revenue cycle reporting strongly preferred.
- Experience working with Medicare, Medicaid, and commercial insurance payers.
- Thorough knowledge of provider credentialing and payer enrollment processes.
- Ability to extract, organize, analyze, and present complex data.
- Ability to manage multiple priorities while meeting deadlines.
- Excellent written and verbal communication skills.
- High level of accuracy and attention to detail.
- Ability to work independently while collaborating effectively with cross-functional teams.
