About the Role
The Credentialing Specialist ensures healthcare providers are properly credentialed and re-credentialed according to regulatory and payer requirements, maintaining accurate records and supporting timely onboarding.
Responsibilities
- Process initial and re-credentialing applications for healthcare providers
- Verify licensure, certifications, and professional references
- Maintain accurate provider files in compliance with accreditation standards
- Respond to credentialing inquiries from providers and internal teams
- Track credentialing deadlines and follow up on pending items
- Submit provider data to insurance payers and third-party systems
- Ensure adherence to NCQA, CMS, and other regulatory guidelines
- Coordinate with enrollment teams to support provider onboarding
- Audit credentialing files for completeness and accuracy
- Update provider information in internal databases and portals
- Manage correspondence related to credentialing status
- Prepare reports on credentialing cycle times and backlogs
- Identify and resolve discrepancies in provider documentation
- Support audits and accreditation reviews
- Collaborate with compliance to address policy changes
- Maintain confidentiality of sensitive provider data
- Escalate complex cases to supervisory staff when necessary
- Follow standardized procedures for file retention and archiving
- Assist in onboarding new credentialing team members
- Participate in process improvement initiatives
- Stay current with industry credentialing standards and updates
- Use case management tools to track progress and outcomes
- Ensure timely responses to payer credentialing requests
- Coordinate with external verification services
- Support special projects related to provider data integrity
Nice to Have
- Certification as a Certified Provider Credentialing Specialist (CPCS)
- Experience with credentialing software such as VeriDoc or CredSimple
- Prior work with Medicaid or Medicare credentialing
- Familiarity with National Practitioner Data Bank (NPDB) queries
- Background in managed care organizations or health systems
- Knowledge of state-specific credentialing requirements
- Experience supporting audits or accreditation submissions
- Exposure to telehealth provider credentialing
- Advanced proficiency in database management
- Training in healthcare compliance or risk management
Compensation
Competitive salary based on experience
Work Arrangement
Remote
Team
Small, agile team focused on healthcare administration
Why This Role Matters
- Accurate credentialing protects patient safety and ensures provider eligibility.
- This role directly impacts provider network integrity and payer compliance.
What to Expect
- Daily work involves reviewing documents, verifying data, and tracking submissions.
- You will collaborate with internal teams and external entities to maintain compliance.
Not available
