Credentialing Specialist

Job Summary

Managing the full scope of provider credentialing and payer enrollment functions, the full-time Credentialing Specialist will ensure compliance with regulations and support timely onboarding for healthcare providers in a remote environment.

Key responsibilities

• Coordinate initial credentialing, recredentialing, and payer enrollment processes for healthcare providers across all facilities
• Maintain accurate documentation and prepare audit-ready files in compliance with internal policies and regulatory standards
• Serve as a liaison between credentialing and other departments, tracking progress and communicating issues to stakeholders

Required qualifications

• Minimum of two (2) years of experience in provider credentialing or payer enrollment in a healthcare setting
• High School Diploma or General Education Development (GED) required
• Proficiency with CAQH, PECOS, NPPES, and payer enrollment portals
• Familiarity with CMS regulations and Hawaii-specific Medicaid requirements
• Experience with credentialing software is preferred