Credentialing and Privileging Specialist

At Highmark Health, we are seeking an experienced Credentialing and Privileging Specialist to join our team. This individual will be responsible for performing critical administrative functions to ensure that providers have the necessary credentials and privileges to provide services. The ideal candidate will have a passion for detail and a drive to make a positive impact. To be successful in this role, the candidate must have a minimum of three years of credentialing and privileging experience in a healthcare setting. The candidate must also possess excellent communication skills and be able to handle multiple tasks in a fast-paced, ever-changing environment. Additionally, the candidate must be proficient in Microsoft Office Suite and have experience with credentialing databases.

Responsibilities:

1. Manage the credentialing and privileging process for providers, ensuring that all necessary paperwork is completed and up to date.
2. Update and maintain provider credentialing and privileging information in credentialing databases.
3. Review credentials and privileging documents for accuracy and completeness.
4. Stay current on changes to applicable laws, regulations, and standards that govern credentialing and privileging.
5. Monitor and track provider credentialing and privileging status to ensure compliance.
6. Respond to requests for information from internal and external stakeholders.
7. Assist in the development of policies and procedures related to credentialing and privileging.
8. Provide support to providers for any credentialing or privileging related issues.
9. Serve as a resource to other departments on credentialing and privileging matters.
10. Track and report on metrics related to credentialing and privileging activities.

According to JobzMall, the average salary range for a Credentialing and Privileging Specialist in Pittsburgh, PA, USA is $45,000 - $60,000 per year.

Highmark Inc. is among the largest health insurers in the United States and the fourth-largest Blue Cross and Blue Shield-affiliated company. Highmark and its diversified businesses and affiliates operate health insurance plans in Pennsylvania, Delaware and West Virginia that serve 5.2 million members. Its diversified health businesses serve group customer and individual health needs across the United States through dental insurance, vision care and other related health businesses. Highmark is an independent licensee of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield companies.