Credentialing Specialist

Job Summary

To support timely and compliant provider onboarding, the full-time Credentialing Specialist will manage the credentialing, recredentialing, and payer enrollment processes for healthcare providers, ensuring adherence to regulatory standards while working remotely.

Key responsibilities:

• Coordinate the end-to-end process of initial credentialing and payer enrollment for healthcare providers across all facilities
• Ensure accurate documentation and compliance with internal policies and external regulations, preparing for audits as necessary
• Serve as a liaison among various departments, tracking credentialing progress and communicating updates to stakeholders

Required qualifications:

• Minimum of two 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