Credentialing Specialist

HGA Support Services•Muskegon, MI

19h

About The Position

Credentialing Specialist HGA Support Services is seeking a highly organized and detail-oriented Credentialing Specialist to support our growing team of providers and services. This role plays a critical part in ensuring our providers meet all regulatory, payer, and agency compliance standards so we can continue delivering high-quality care to the individuals and families we serve. If you thrive in a structured, compliance-focused role and take pride in keeping systems accurate and up to date, we’d love to hear from you. Position Summary The Credentialing Specialist is responsible for managing the full credentialing lifecycle for licensed and independent providers. This includes initial credentialing, recredentialing (every three years), monthly compliance monitoring, and payer enrollment tracking through systems such as CAQH and the State of Michigan CHAMPS system. This position works closely with HR, Compliance, Billing, and Leadership to ensure HGA Services remains fully compliant with state, federal, Medicaid, and payer requirements.

Requirements

High school diploma required
1–3 years of healthcare credentialing experience preferred
Experience with Medicaid enrollment and provider payer portals preferred
Experience using the CHAMPS system strongly preferred
Experience managing CAQH profiles preferred
Strong attention to detail and ability to manage multiple deadlines
Excellent organizational and documentation skills
Proficiency in Microsoft Office and database systems
Ability to handle confidential information with discretion

Nice To Haves

Associate’s or Bachelor’s degree preferred
A self-starter who can manage processes independently
Someone comfortable working with compliance standards and documentation requirements
Strong follow-through and deadline management
A team player who supports HGA’s mission and values

Responsibilities

Manage initial credentialing and recredentialing processes for psychiatric providers, BCBAs, and other licensed professionals
Conduct primary source verifications for licenses, certifications, education, training, and work history
Maintain and manage provider profiles within CAQH , including document uploads and required 120-day attestations
Complete and monitor Medicaid enrollment and updates through the CHAMPS system
Submit and track commercial payer enrollments
Track and maintain provider expiration dates (licenses, certifications, liability insurance, etc.)
Conduct required monthly exclusion checks (OIG, SAM, and state databases)
Maintain organized electronic credentialing files
Ensure compliance with Medicaid, payer, and agency policies
Prepare documentation for audits and regulatory reviews
Communicate proactively with providers regarding documentation needs and deadlines
Collaborate with billing to ensure providers are enrolled and billable prior to service delivery