Credentialing Specialist

Job Summary

To support a growing healthcare organization, the full-time hybrid Payer & Enrollment Credentialing Specialist will coordinate credentialing and re-credentialing activities for physicians and providers, ensuring compliance with organizational and regulatory standards while working both in-office and remotely on a rotating schedule.

Key responsibilities

• Implement and monitor procedures related to credentialing, re-credentialing, and privileging of network providers
• Process provider applications and maintain the provider profiling system, ensuring high quality standards are met
• Lead training initiatives for less experienced specialists and conduct regular file audits

Required qualifications

• Associate's degree preferred
• Three years of credentialing experience in a managed care plan or medical staff services
• Strong analytical skills with the ability to interpret data effectively
• Proficient understanding of credentialing accreditation standards such as Joint Commission, NCQA, and URAC
• Demonstrated knowledge of initial credentialing and re-credentialing practices, including primary source verification methods