Credentaling Maintenance Specialist

Job Description

Job Description

Description:

Job Summary

The Credentialing Maintenance Specialist is responsible for the ongoing maintenance of provider records to ensure clinicians remain compliant, accurately represented with contracted health plans, and eligible to provide services throughout their employment. This role manages provider demographic changes, license and certification maintenance, recurring credentialing updates, CAQH attestations, payer directory accuracy, and provider maintenance requests. The Credentialing Maintenance Specialist serves as a liaison between providers, internal departments, and payer organizations to ensure provider information remains current and supports uninterrupted network participation and reimbursement.

Essential Duties and Responsibilities

1. Maintain accurate provider demographic information across internal systems, credentialing platforms, and payer portals.
2. Coordinate provider maintenance requests, including name changes, address updates, supervising provider relationships, tax identification updates, and other demographic changes.
3. Monitor provider licenses, certifications, DEA registrations (when applicable), malpractice insurance, and other required credentials to ensure timely renewals and compliance.
4. Complete recurring CAQH profile reviews and attestations to maintain accurate provider information and meet payer requirements.
5. Update provider information within payer portals and directories, ensuring directory accuracy and compliance with payer maintenance requirements.
6. Respond to payer inquiries regarding provider demographics, credentialing status, and appointment availability.
7. Coordinate provider appointment availability updates and respond to network adequacy and directory validation requests from contracted health plans.
8. Maintain provider records within credentialing software, MedTrainer, and other organizational systems.
9. Partner with Credentialing Enrollment Specialists to communicate provider maintenance changes requiring payer notification or enrollment updates.
10. Collaborate with Clinical Operations, Human Resources, Compliance, and Revenue Cycle to ensure provider information remains accurate across all systems.
11. Maintain organized documentation of provider maintenance activities, payer confirmations, and supporting records.
12. Monitor regulatory and payer requirements related to provider maintenance and recommend process improvements as needed.
13. Assist with internal audits and compliance initiatives by ensuring provider records remain complete, accurate, and audit ready.

Qualifications

• Exceptional organizational skills with strong attention to detail and a commitment to accuracy.
• Ability to manage multiple provider maintenance, recredentialing, revalidation, and compliance-related activities while meeting established deadlines.
• Strong prioritization and time management skills, with the ability to balance competing priorities in a fast-paced environment.
• Knowledge of provider recredentialing, revalidation, licensure, certification, and ongoing payer participation requirements across multiple states and payer networks.
• Proficient in Microsoft Office Suite, CAQH, payer portals, and credentialing/provider management systems.
• Experience maintaining provider records, monitoring credential expiration dates, and coordinating required updates to ensure ongoing compliance.
• Strong verbal and written communication skills, with the ability to effectively interact with providers, payers, licensing boards, and internal stakeholders.
• Ability to interpret and apply payer, regulatory, accreditation, and organizational requirements related to provider maintenance and recredentialing.
• Thorough understanding of confidentiality requirements and the ability to handle sensitive provider and organizational information with discretion.
• Ability to work independently while collaborating effectively with Credentialing, Revenue Cycle, Compliance, Human Resources, and Clinical Operations teams.
• Experience tracking and coordinating provider revalidations, licensure renewals, certifications, and payer maintenance activities to support uninterrupted provider participation.

Education/Experience Requirements

• High school diploma or equivalent required
• Associate's or Bachelor's degree in Healthcare Administration, Business Administration, or a related field preferred.
• Minimum of two (2) years of experience in provider enrollment, credentialing, healthcare administration, or a related healthcare support role.
• Experience coordinating provider recredentialing, revalidation, licensure renewals, certifications, and payer maintenance activities preferred.

Physical Requirements

While performing the duties of this job, the employee is regularly required to sit for prolonged periods of time. The team member is occasionally required to stand, walk, and use hands to operate a computer keyboard. The team member may occasionally lift and or move up to 25 pounds. Vision requirements include close vision, distance vision, depth perception and the ability to adjust focus.

Company Overview:

Lighthouse Autism Center is the leading Applied Behavior Analysis (ABA) therapy provider in Indiana, Iowa, Nebraska, North Carolina, Michigan and expanding within those states and other states across the U.S. Since 2012, Lighthouse Autism Center has provided the highest quality, center-based ABA therapy to children with autism. At Lighthouse, children work on things like social skills, daily living skills, communication skills, and school-readiness skills. All children are overseen by Board Certified Behavior Analysts and programs are implemented by Registered Behavior Technicians. Lighthouse Autism Center also has full-time Speech-Language Pathologists on staff who provide co-treat and consultative services speech therapy services to children who attend the centers.