Job Description

Description
The Credentialing Specialist is responsible for coordinating initial credentialing and recredentialing activities for practitioners and other healthcare providers in accordance with organizational policies, payer requirements, and applicable accreditation/regulatory standards. This role performs primary source verification, monitors licensure and sanctions/exclusions, and maintains complete and audit-ready credentialing files to support timely provider onboarding and ongoing compliance.
Requirements
Education
Minimum: High School diploma or equivalent
Experience
Minimum: One year of experience in credentialing, provider enrollment, medical staff services, or a related healthcare administrative role.
Preferred: Two or more years of experience performing primary source verification and managing credentialing files in a medical group, hospital, IPA, MSO, or health plan.
Skills, Knowledge & Abilities
Strong organizational and time-management skills with the ability to manage multiple credentialing files and deadlines simultaneously.
Effective verbal and written communication skills, including professional follow-up with providers and internal stakeholders.
Proficiency with credentialing systems, databases, and standard office software (e.g., Microsoft Office).
Knowledge of primary source verification methods and common credentialing documentation requirements.
Understanding of payer credentialing requirements and delegated credentialing concepts (as applicable).
Ability to identify discrepancies or red flags and escalate appropriately while maintaining documentation standards.
Knowledge of HIPAA and confidentiality requirements related to provider files and sensitive information.
Ability to work independently while collaborating effectively with interdisciplinary teams and maintaining attention to detail.

Job Tags

Work at office

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