About the Role
This role is responsible for verifying and maintaining provider credentials to ensure compliance with regulatory and accreditation standards. The specialist manages end-to-end credentialing processes, supports audits, and collaborates with internal teams to ensure timely provider onboarding.
Responsibilities
- Verify healthcare provider licenses, certifications, and professional history
- Process initial and recredentialing applications within established timelines
- Maintain accurate and up-to-date provider credentialing files
- Communicate with providers and facilities to collect required documentation
- Ensure compliance with NCQA, CMS, and state regulatory requirements
- Support internal and external audits by providing credentialing records
- Collaborate with enrollment teams to coordinate provider onboarding
- Monitor expiration dates and initiate recredentialing workflows
- Utilize credentialing databases to track application status
- Resolve discrepancies in provider-submitted information
- Ensure adherence to accreditation standards across all processes
- Maintain confidentiality of sensitive provider data
- Assist in credentialing process improvements and workflow optimization
- Respond to internal inquiries regarding provider credentialing status
- Coordinate with quality and compliance teams on credentialing-related issues
- Prepare reports on credentialing metrics and turnaround times
- Stay current with changes in healthcare regulations and credentialing guidelines
- Support provider enrollment in insurance networks when required
- Facilitate communication between providers and administrative teams
- Ensure accurate data entry and system updates throughout the lifecycle
Compensation
Competitive hourly wage or salary based on experience and location.
Work Arrangement
Hybrid work model with a combination of remote and on-site responsibilities.
Team
Part of the provider enrollment and credentialing team supporting clinical operations.
Why This Role Matters
- Accurate credentialing ensures patients receive care from qualified providers, directly impacting quality and safety.
- This role supports regulatory compliance and helps maintain accreditation for healthcare facilities.
What to Expect
- Structured processes with clear timelines for credentialing cycles.
- Regular interaction with providers, administrators, and compliance teams.
Not available for this position.
