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 provider onboarding while working remotely.

Key responsibilities

• Coordinate the end-to-end process of initial credentialing, recredentialing, and payer enrollment for healthcare providers
• Maintain accurate documentation and prepare audit-ready files in compliance with internal policies and standards
• Serve as a liaison between credentialing and various departments, tracking progress and communicating issues 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