Credentialing Specialist

Job Summary

To ensure healthcare partners meet regulatory requirements, the full-time Credentialing Specialist will manage provider onboarding, maintain accurate provider data, and perform primary source verifications in a remote environment.

Key responsibilities

• Facilitate provider onboarding by ensuring documentation is complete and compliant with industry standards
• Perform timely follow-ups with providers on pending applications and maintain provider information in various systems
• Conduct primary source verifications according to departmental policies and respond to inquiries regarding application statuses

Required qualifications

• Associate degree or equivalent combination of education and experience
• 3 years of credentialing experience, preferably in a managed care setting
• Working knowledge of NCQA standards and payer credentialing standards
• Strong computer, data entry, and clerical skills
• Ability to maintain internet service suitable for remote work