Credentialing Specialist I

Cure 4 The Kids Foundation•Las Vegas, NV

11d•Onsite

About The Position

Cure 4 The Kids Foundation is seeking a Credentialing Specialist I to coordinate provider credentialing, privileging, re-credentialing, and payer enrollment while maintaining accurate, survey-ready files. The role manages credentialing and enrollment processes for providers, works independently within established policies, and escalates complex findings to the Credentialing Specialist II. This is a non-exempt, hourly position supporting a multidisciplinary clinical team focused on care for children and their families. The specialist works with organizational leaders, team members, providers, health plans, facilities, and other external entities. The role also supports accreditation readiness, process improvement, departmental projects, and accurate maintenance of provider and staff credentialing information. The position is based in a clinical and administrative environment on the Roseman University Campus in Summerlin.

Requirements

High school diploma or GED.
Working knowledge of credentialing standards, including Joint Commission, state, and payer requirements, and primary source verification.
Computer skills, including Word, Excel, PowerPoint, and the ability to learn and use proprietary software programs.
Strong written and oral communication and interpersonal skills with colleagues, management, providers, health plans, and state regulatory bodies.
Attention to detail and strong organizational skills, including managing multiple priorities and consistent follow-up.
Ability to work independently with minimal supervision, escalate concerns appropriately, and adapt to change.
Ability to research, analyze data, and organize findings.
Frequent sitting and prolonged computer use, including repetitive keyboarding and mouse operation; frequent face-to-face telephone contacts and visual acuity for office equipment and keyboard use; occasional standing, walking, bending, reaching, and lifting or carrying items up to 10 pounds.

Nice To Haves

At least two years of provider credentialing or medical staff services experience within the past five years, including primary source verification, license and expirable tracking, and re-credentialing.
Associate degree.
Certified Provider Credentialing Specialist (CPCS) certification.
Hospital medical staff or payer enrollment experience, including CAQH.
Direct experience with Joint Commission credentialing and privileging standards or survey support.
Experience with credentialing databases and practice management software.

Responsibilities

Maintain professionalism and positive working relationships with organizational leaders, team members, patients, families, partners, and stakeholders.
Respond to emails in a timely manner, participate in mandatory training, and help maintain a clean, safe, and gossip-free working environment.
Manage internal and external provider credentialing, privileging, and re-credentialing, including hospital applications, and monitor applications and contracts through completion.
Complete payer enrollment, re-validation, and provider updates; maintain CAQH profiles and attestations and update payer portals.
Maintain current provider licenses, DEA certificates, malpractice coverage, and other required documents, and manage license renewals.
Conduct license monitoring in accordance with organizational policy, including initiating letters and reports and performing primary source verification of renewals.
Perform primary source verification and exclusion and sanction checks in accordance with organizational policy.
Review credentialing files for completeness and accuracy, identify missing, expired, or concerning items, document follow-up and resolution, and escalate issues to the Credentialing Specialist II as needed.
Create and maintain provider and staff credentialing binders and ensure information is accurately maintained in online credentialing databases.
Keep practice information accurate and current with health plans, payer portals, facilities, and other entities.
Update payer and provider credentialing information in practice management software and communicate relevant updates to appropriate personnel.
Maintain, update, and create physician privileges and credentialing forms in coordination with the Credentialing Specialist II.
Support accreditation readiness led by the Credentialing Specialist II, including file audits, checklists, and preparation for unannounced surveys.
Document credentialing workflows, support process improvements, and test new processes and tools, including AI, while providing actionable feedback.
Support special projects and departmental initiatives, and perform other duties as assigned.