Lead Credentialing Specialist

Job Summary

Responsible for all aspects of provider enrollment, credentialing, recredentialing and privileging as requested for all billing/credentialing client providers (medical, dental, mental health) with respective health plans and/or facilities. Responsible for maintaining up to date data for each provider in credentialing databases and online systems; ensuring timely renewal of licenses and certifications.


  • High School education required.
  • 2 years of applicable higher education preferred.
  • 2 years of relevant credentialing experience preferred.
  • Certified Provider Credentialing Specialist (CPCS) preferred.


  • Knowledge of current health plan and agency requirements for credentialing providers.
  • Knowledge of computer operations including Microsoft Office applications, credentialing software and internet applications.
  • Knowledge of billing procedures in a medical office setting.
  • Ability to key 60 wpm.
  • Demonstrates a high level of motivation and initiative to accomplish goals with minimal supervision.
  • Superior communication skills both oral and written.
  • Ability to establish and maintain effective working relationships with providers, management, staff, and contacts outside the organization.
  • Knowledge of Federal, State, and Local legal, compliance & regulatory provision related to billing practices in a medical office.
  • Ability to organize and prioritize work and manage multiple priorities.
  • Excellent attention to detail.
  • Ability to research and analyze data.
  • Ability to work well independently or with a group.

Teamwork Aptitude

  • Commitment: Participates and is part of the team.
  • Control: Moves forward within the discipline of the team.
  • Contagious: Brings a positive and enthusiastic attitude to the team.
  • Communication: Listens and openly discusses issues facing the team.
  • Comfortable: Builds trust and open working relationships within the team.
  • Creative: Works with the team to bring synergy to the resolution of issues for the team.

Customer Service Skills

  • Presents a positive attitude to the public; treats each customer with respect, dignity, and kindness.
  • Maintains a businesslike and professional demeanor in all dealings with the public.
  • Listens and learns what the customer wants before helping customers resolve issues.
  • Goes the extra mile to help customers resolve their issues.

Company Values/Compliance/Safety

  • Supports the Mission, Vision and Values of Moore Support Services, INC
  • Follows all policies/procedures of the Company’s Corporate Compliance Plan, HIPAA.
  • Reports any incidents/violations of Privacy/Security and OSHA/Safety policies to management.
  • Maintains the strictest confidentiality in all functions as it relates to company financial/proprietary information and patient protected health information.
  • Demonstrates a commitment to service excellence and quality improvement.

Job Duties and Responsibilities

  • Compiles and maintains current and accurate data for all providers including but not limited to licenses, DEA, continuing education, malpractice coverage, Curriculum Vitae, and Universal Practitioner Application.
  • Completes provider credentialing and recredentialing applications; monitors applications and follows-up as needed. Completes provider privileging applications as requested.
  • Sets up and maintains group contracts with health plans.
  • Sets up and maintains provider information in online credentialing databases (ie. CAQH) and Modio credentialing database.
  • Tracks license and certification expirations for all providers to ensure timely renewals.
  • Reports credentialing status to providers/offices/clinics.
  • Ensures practice addresses are current with health plans, agencies and other entities.
  • Audits Payer/Health Plan rosters for current and accurate provider information.
  • Maintains the highest level of customer service within the Billing Office.
  • Makes recommendations to supervisory and administrative staff regarding any improvements in efficiency and/or effectiveness of the company operations.
  • Maintains orderly files and workspace.
  • Handles back up duties for other staff members when they are on leave as assigned by Manager.
  • Corresponds, attends administrative/team meetings, assists and keeps ongoing communication with Manager.
  • Handles any other duties as assigned by Relationship Manager.

Environment / Working Conditions

  • Cubicles are in a well-lighted office environment.
  • Cubicles are in relatively close proximity; employees must be able to concentrate with a moderate amount of distraction and noise.
  • Requires use of a computer, keyboard and normal office equipment (e.g., fax machine, photocopier, etc).


  • Secure HIPAA work environment
  • Stable internet connection
  • Windows 10V or above for applications to work
  • Bluetooth headset

Physical Demands

  • Requires sitting for extend periods of time; standing; walking; stooping or kneeling; reaching with hands and arms; talking and hearing.
  • Manual dexterity using computer keyboard/calculator.
  • May occasionally be required to lift and/or move up to 40 pounds.

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