Credentialing Specialist

Lumeris

1d•$39,000 - $48,150•Remote

About The Position

At Lumeris, we believe that our greatest achievements are made possible by the talent and commitment of our team members. That's why we are actively seeking talented and collaborative individuals who are passionate about making a difference in the healthcare industry. Join us today as we strive to create a system of care that every doctor wants for their own family and become part of a community that values its people and empowers you to make an impact. Position: Credentialing Specialist Position Summary: The Credentialing Specialist is responsible for coordinating and executing credentialing and re credentialing activities for contracted providers and Health Delivery Organizations (HDOs) in accordance with health plan requirements, state and federal regulations, and NCQA standards. This role ensures the accuracy, integrity, and completeness of credentialing data, supports Credentialing Committee review, and serves as a key liaison with providers, internal partners, vendors, and clients.

Requirements

High school diploma, GED, or equivalent
1+ year of experience in healthcare operations, credentialing, or a related field (or equivalent knowledge, skills, and abilities)
Familiarity with health plan or credentialing systems
Proficiency in Microsoft Office and Adobe Acrobat
Strong verbal and written communication skills
Exceptional attention to detail and commitment to accuracy
Strong organizational, multitasking, and time‑management skills
Ability to prioritize workload and meet deadlines in a fast‑paced, collaborative environment

Nice To Haves

Associate or Bachelor’s degree in healthcare administration, public health, or a related field
Credentialing or licensure experience
Working knowledge of industry standards and regulations (e.g. NCQA, state and federal requirements)

Responsibilities

Credentialing Operations Monitor ongoing provider compliance, professional license sanctions, and quality indicators.
Maintain accurate, complete, and timely credentialing records within credentialing software systems.
Data Integrity & Verification Prepare, validate, and submit credentialing data files to the Credentialing Verification Organization (CVO).
Review, validate, and document the accuracy of CVO‑completed work.
Identify discrepancies, outstanding issues, or risks within credentialing files and work collaboratively to resolve them.
Validate credentialing data used for Credentialing Committee materials and reporting.
Collaboration & Communication Communicate effectively with providers, physicians, vendors, and internal stakeholders to obtain required documentation.
Partner cross‑functionally with contracting, client services, and internal departments to exchange provider information and drive efficiency.
Assist clients, internal partners, and vendors with credentialing‑related questions, outreach, and documentation needs.
Provide regular (weekly) status updates to assigned clients.
Reporting & Compliance Prepare Credentialing Committee materials, including documentation of issues and resolutions.
Assist with monthly file sampling, audits, SDMC/QMC reporting, and re‑credentialing reports.
Prepare denial and “criteria not met” notification letters to providers, as applicable.
Maintain a strong working knowledge of federal, state, and local credentialing regulations across supported markets.
Quality & Confidentiality Ensure strict confidentiality of privileged and sensitive information.
Demonstrate exceptional attention to detail and accuracy across all credentialing activities.
Support delegated credentialing assessments and ongoing monitoring activities.
Perform additional duties as assigned to support credentialing and organizational goals.