Credentialing Specialist

Job Summary

Seeking a detail-oriented Provider Enrollment & Credentialing Specialist, the full-time role will manage provider licensing, credentialing, and enrollment processes for a multi-state virtual clinical network while ensuring compliance with NCQA standards.

Key responsibilities

• Oversee end-to-end execution of provider licensing, renewals, re-credentialing, and payer enrollment across all states
• Manage the onboarding process from provider acceptance to ready-to-practice status, ensuring timely communication with Clinical Operations and People teams
• Maintain audit-ready documentation and translate NCQA standards into operational workflows and policies

Required qualifications

• 3+ years of experience in credentialing, provider enrollment, or medical staff services in a multi-provider environment
• Demonstrated NCQA credentialing and re-credentialing experience in daily operations
• Experience with multi-state licensure management and compliance monitoring
• Fluency in credentialing documentation processes, including primary-source verification and CAQH
• Proven ability to manage high-volume tasks while effectively communicating with various stakeholders