Apply on Employer Site

MetroEHS Pediatric Therapy · 1 month ago

Credentialing Specialist and HR Administrative Support

Plymouth, Michigan, United States

Full-time

Onsite

Entry, Mid Level

2+ years exp

MetroEHS Pediatric Therapy is seeking a Credentialing Specialist and HR Administrative Support to manage provider credentialing and provide administrative support to the HR department. The role involves overseeing the credentialing lifecycle, ensuring compliance, and assisting with HR operations and record maintenance.

Health CareHospitalPsychologyTherapeuticsTraining

Growth Opportunities

Responsibilities

Manage the full-cycle credentialing, recredentialing, and CAQH attestation process for all clinical providers, including Physical Therapists, Occupational Therapists, Speech-Language Pathologists, Board Certified Behavior Analysts, Registered Behavior Technicians, Social Workers, and other licensed professionals

Complete and submit credentialing and enrollment applications for both commercial/private insurance payers and county-specific Community Mental Health (CMH) entities

Maintain accurate, audit-ready credentialing records and tracking systems for all applications, deadlines, and payer requirements

Monitor expirations for licenses, certifications, malpractice insurance, and other required documents; send reminders and ensure timely renewals

Review provider documentation (licenses, certifications, malpractice coverage, NPI, CAQH, education/experience records) for completeness and accuracy prior to submission

Ensure CAQH profiles are kept current, including timely attestations and document updates for all providers

Serve as the primary point of contact between the organization and insurance payers/CMH entities to address application questions, missing information, or follow-up requests

Maintain up-to-date knowledge of payer-specific credentialing criteria, enrollment processes, contractual requirements, and policy changes that may impact provider status or reimbursement

Verify provider credentials during onboarding and ensure all necessary documents and data are collected before initiating the credentialing process

Conduct primary source verifications in accordance with federal, state, payer, and accreditation requirements

Communicate credentialing status updates and expected timelines to internal stakeholders, including HR, Billing, Finance, and Clinical Leadership

Track and manage payer recredentialing cycles to ensure continuous provider participation without lapses in authorization or reimbursement

Troubleshoot and resolve credentialing or enrollment issues that may impact claims processing, provider participation, or revenue cycle operations

Support contract negotiation or amendment processes by providing credentialing-related data and coordinating payer documentation as needed

Participate in internal audits, compliance reviews, and quality improvement initiatives related to credentialing operations

Support onboarding processes, including collecting documentation, preparing new hire files, and assisting with system setup

Maintain accurate employee records, digital files, and HR documentation in accordance with company policy, county-specific compliance standards, and retention requirements

Assist in scheduling meetings, training, and compliance-related activities

Provide general HR administrative support such as data entry, correspondence, scanning, and filing

Support HR projects, compliance initiatives, and process improvements as needed

Qualification

Medical credentialingProvider enrollmentCAQH managementHRIS softwareHealthcare complianceOrganizational skillsAttention to detailTime managementWritten communicationVerbal communication

Required

Associate's degree required

2+ years of experience in medical credentialing, provider enrollment, or a healthcare compliance role

Strong understanding of credentialing requirements, CAQH management, NPI registry processes, and payer enrollment workflows

Must possess exceptionally strong organizational skills, with the ability to manage detailed credentialing workflows, track multiple deadlines, and maintain accurate, up-to-date documentation in a fast-paced environment

Demonstrated ability to work independently, solve problems proactively, and follow complex, multi-step processes

Excellent attention to detail and accuracy

Strong organizational and time-management abilities

Ability to handle sensitive information with confidentiality

Proficiency in Microsoft Office and HRIS/credentialing software systems

Effective written and verbal communication skills

Ability to prioritize and manage multiple tasks in a deadline-driven environment