Credentialing Specialist Jobs

About The Position

Requirements

• High school diploma required
• Strong attention to detail and organizational skills.
• Ability to manage multiple tasks and meet deadlines.
• Strong written and verbal communication skills.
• Proficiency in Microsoft Office and database systems.

Nice To Haves

• Associate's degree preferred.
• Prior healthcare or credentialing experience preferred.
• Working knowledge of CAQH and credentialing processes preferred.

Responsibilities

• Review onboarding and credentialing documentation for completeness and accuracy.
• Prepare and submit credentialing and recredentialing applications for providers and facilities.
• Track application status and maintain detailed logs of pending and completed submissions.
• Conduct follow-up with payers, providers, and internal stakeholders regarding application status.
• Monitor and notify providers of upcoming license, certification, and credential expirations.
• Perform primary source verification and registry checks in accordance with established requirements.
• Create and maintain CAQH profiles and ensure all data is accurate and current.
• Enter and maintain credentialing data in internal systems with a high level of accuracy.
• Assist with audits, roster reconciliations, and compliance-related reporting.
• Support onboarding and offboarding credentialing activities.
• Communicate credentialing status updates to appropriate stakeholders.
• Performs work based on established procedures, guidelines, and workflows.
• Escalates issues, delays, or compliance concerns to the Credentialing Manager.