About the Role
The Senior Credentialing Specialist will oversee the full lifecycle of provider credentialing and re-credentialing, ensuring accuracy, compliance, and efficiency in enrollment across federal, state, and commercial payer requirements.
Responsibilities
- Manage end-to-end credentialing and re-credentialing for healthcare providers
- Verify provider licenses, certifications, and professional references
- Submit applications to insurance payers and track submission status
- Ensure compliance with NCQA, CMS, and other regulatory standards
- Maintain accurate provider records in credentialing databases
- Respond to audits and requests for documentation
- Collaborate with enrollment teams to support provider onboarding
- Identify and resolve discrepancies in application materials
- Monitor credentialing timelines and drive process improvements
- Serve as a point of contact for internal stakeholders on credentialing status
- Review primary source verification documentation
- Support compliance with Medicare and Medicaid enrollment rules
- Coordinate with state licensing boards and professional associations
- Maintain up-to-date knowledge of payer-specific credentialing requirements
- Assist in training team members on credentialing best practices
- Prepare reports on credentialing metrics and turnaround times
- Ensure timely submission of re-credentialing applications
- Work with legal and compliance teams on policy updates
- Facilitate communication between providers and internal departments
- Support quality improvement initiatives within credentialing workflows
Nice to Have
- Certification in healthcare credentialing (e.g., CPC, CPCE)
- Experience with electronic credentialing platforms
- Background in primary care or value-based care models
- Familiarity with Medicare Advantage plans
- Prior work in a patient-centered medical home environment
Compensation
Competitive salary and benefits package offered
Work Arrangement
Hybrid work model with both remote and office-based options
Team
Part of a dedicated provider operations team focused on streamlining onboarding and compliance
About the Team
This role is part of a national provider operations team dedicated to scaling high-quality care delivery through efficient credentialing and enrollment processes.
Impact
Your work ensures providers are credentialed accurately and on time, directly supporting patient access to care and operational readiness.
Not available for this position
