Credentialing Specialist

Job Description

Job Description

We are looking for a Credentialing Specialist to support provider enrollment and reappointment activities. This long-term contract position focuses on coordinating accurate, timely credentialing documentation, maintaining provider records, and helping ensure licenses and certifications remain current. The ideal candidate brings strong follow-through, sound judgment, and the ability to work closely with providers and internal stakeholders to keep credentialing workflows on schedule.

Responsibilities:

• Experience in NCQA Credentialing for the state of IL

• Guide healthcare providers through initial credentialing and recredentialing submissions, ensuring all required materials are completed and returned within established timelines.

• Examine application packets for accuracy and completeness, then follow up promptly to resolve missing information or supporting documentation.

• Encourage timely submission of signed applications, aiming to secure completed paperwork within 10 days of the original request.

• Partner with credentialing team members to gather outstanding records and keep processing deadlines on track.

• Enter and maintain provider profiles in credentialing platforms and databases, ensuring information remains current and reliable.

• Produce recurring reports on upcoming expirations for licenses, certifications, and related credentials so renewal activity can begin early.

• Monitor renewal status for medical licenses, board certifications, liability coverage, and other required credentials to prevent lapses.

• Escalate unresolved expiration issues as needed and communicate with providers and medical staff offices to confirm active licensure and privileges.

• Experience supporting provider, physician, or healthcare credentialing activities in a clinical, hospital, or managed care environment.
• Working knowledge of initial application processing, reappointment cycles, and standard credentialing documentation requirements.
• Ability to review detailed records carefully and identify incomplete, inaccurate, or missing information.
• Strong organizational skills with the ability to manage multiple deadlines and maintain consistent follow-up.
• Proficiency with Microsoft Excel and comfort using online databases or credentialing systems.
• Effective written and verbal communication skills for coordinating with providers and internal teams.
• High level of accuracy, professionalism, and discretion when handling sensitive provider information.