Credentialing Specialist
Position Summary
The Credentialing Specialist is responsible for managing the full credentialing lifecycle for healthcare providers, including primary source verification, CAQH maintenance, payer credentialing, recredentialing, and ongoing monitoring. This role ensures accuracy, compliance, and timely completion of all credentialing activities. The ideal candidate is organized, proactive, and experienced in credentialing workflows and payer requirements.
Key Responsibilities
- Complete and manage credentialing and recredentialing applications for providers across multiple specialties.
- Perform primary source verification (PSV) for licenses, certifications, education, training, and work history.
- Maintain and update CAQH profiles, NPPES records, and other credentialing databases.
- Track credentialing deadlines, expirables, and recredentialing cycles to ensure continuous compliance.
- Communicate professionally with providers, payers, and internal teams to obtain required documentation and resolve issues.
- Review applications for accuracy, completeness, and compliance with federal, state, and payer‑specific standards.
- Maintain detailed credentialing files and documentation in accordance with company policies and regulatory requirements.
- Support onboarding processes by ensuring providers are credentialed and ready for enrollment and billing.
- Identify and escalate credentialing barriers or delays that may impact provider start dates or revenue.
- Protect all provider and organizational information by adhering to confidentiality and compliance standards.
Qualifications
Education
- High School Diploma or equivalent required
- Additional training in healthcare administration, credentialing, or compliance preferred
Experience
- Minimum 2 years of credentialing experience required, FQHC experience is required.
- Experience with CAQH, NPPES, PECOS, and payer credentialing portals
- Familiarity with NCQA, CMS, and payer credentialing standards
Skills & Competencies.
- Strong attention to detail and accuracy.
- Excellent communication and customer‑service skills.
- Ability to manage multiple deadlines and prioritize effectively.
- Strong problem‑solving and follow‑up abilities.
- Proficiency with credentialing software, EHR systems, and payer portals.
- Ability to work independently in a remote or hybrid environment.
- Commitment to confidentiality and compliance.
Work Environment & Benefits
- Fully remote and hybrid positions available.
- Flexible schedules, reports directly to the Credentialing Manager.
- Competitive benefits package.
- Supportive, mission‑driven team culture.
- Opportunities for growth within a rapidly expanding company.