EEE QI - Credentialing Specialist-New Jersey Ave-DC

Job Description

Job Description

Job Title: Credentialing Specialist I
Location: Washington, DC
Organization: Unity Health Care
Employment Type: Full-Time

Under the supervision of the Credentialing Manager, the Credentialing Specialist I administers the credentialing, re-credentialing, and delegated processes. The incumbent works independently to coordinate, develop, monitor, and maintain the credentialing process.

About Unity Health Care

Unity Health Care is the largest network of community health centers in Washington, DC, dedicated to providing high-quality, compassionate care to underserved populations. Our mission is to improve health outcomes and reduce barriers to care by delivering comprehensive, patient-centered services across the District.

Position Summary

The Credentialing Specialist I is responsible for managing and supporting all aspects of the credentialing and re-credentialing processes for healthcare providers and licensed staff. This role ensures compliance with HRSA, NCQA, Joint Commission, and other regulatory standards while maintaining accurate and complete provider credentialing files. The position requires independent judgment, strong organizational skills, and the ability to manage multiple priorities in a fast-paced healthcare environment.

Key Responsibilities

• Implement and oversee all activities related to health professionals’ credentialing and re-credentialing
• Maintain confidential provider credentialing files and ensure accuracy and compliance
• Perform regularly scheduled audits of credentialing files
• Maintain knowledge of HRSA, NCQA, and Joint Commission credentialing requirements
• Monitor regulatory updates impacting credentialing processes
• Analyze and resolve provider file deficiencies and track progress in credentialing databases
• Generate weekly reports as requested by the supervisor
• Review provider file changes and ensure completeness of documentation
• Collaborate with provider offices to obtain missing or required documentation
• Verify licensure, education, training, malpractice coverage, and certifications
• Manage OneApp Pro and retrieve documentation from CAQH files
• Process monthly re-credentialing for licensed staff, including clinical and allied health roles
• Monitor corrective action plans related to credentialing and privileging
• Respond to provider inquiries via phone, email, or written communication
• Conduct onboarding verification of new hire credentials
• Responsible for training new credentialing staff
• Participate in special projects and perform other duties as assigned

Minimum Qualifications

• Bachelor’s degree OR an equivalent combination of education and experience that provides the required knowledge, skills, and abilities
• Three (3) or more years of healthcare credentialing experience OR equivalent combination of education and experience