Credentialing Specialist

About TwelveStone Health Partners

TwelveStone Health Partners is dedicated to supporting patients with chronic, complex, and rare conditions by providing access to advanced medication and comprehensive support services. Operating for over 35 years, the organization simplifies specialty medication treatment for conditions such as Multiple Sclerosis, NMOSD, Myasthenia Gravis, CIDP, ITP, Migraine Prevention, Crohn’s Disease, Ulcerative Colitis, Plaque Psoriasis, Alpha 1 Antitrypsin Deficiency, Primary Immunodeficiency, hATTR Amyloidosis, Thyroid Eye Disease, among others. Licensed in all 50 states, TwelveStone supports transitions across care environments to improve patient health journeys.

Role Summary

The Credentialing Specialist is responsible for managing all administrative duties related to credentialing and verifying documentation for individual practitioners, infusion centers, and home infusion therapy contracts. This role requires submitting accurate applications within assigned turnaround times while adhering strictly to compliance, regulatory, and organizational guidelines.

Primary Responsibilities

• Oversee credentialing and re-credentialing applications, including submission, approval, denial, termination notifications, and provider data management in systems like CAQH and Availity.
• Enroll providers and facilities in state Medicare/Medicaid programs and manage communication with stakeholders to obtain necessary credentialing documents.
• Monitor applications to prevent credentialing lapses by timely follow-ups and escalating missing items to leadership.
• Engage with insurance payors, including Medicare and Medicaid, to resolve credentialing issues via phone, email, and online portals.
• Complete annual revalidations and requirements to ensure up-to-date provider records and uninterrupted payments and authorizations.
• Create and maintain provider files compliant with company policy, ensuring confidentiality and data integrity of credentialing documentation.
• Conduct quality assurance checks to verify enrollment accuracy across payors, CMS, and State Medicaid.
• Foster collaboration with Compliance, Contracting, and Revenue Cycle teams and maintain effective relationships with payor contacts.
• Manage credentialing correspondence, maintain task tracking systems for credentialing workflows, and assist with performance goal setting.
• Perform additional duties and special projects as assigned.

Qualifications

• Minimum education requirement: High School Diploma or GED; Associate’s Degree is advantageous.
• Experience: At least 2 years in payor credentialing or 3+ years in healthcare-related functions such as billing, intake, compliance, or contracting.
• Strong commitment to maintaining confidentiality of protected health information and adherence to HIPAA privacy and security standards.
• Skills required include attention to detail, critical thinking, effective prioritization, problem-solving abilities, excellent phone etiquette, dependability, clear verbal and written communication, teamwork, collaboration, and sound judgment.