Credentialing Specialist

Credentialing SpecialistWe are seeking a detail-oriented Credentialing Specialist to support the credentialing and recredentialing of healthcare providers. This individual will be responsible for verifying provider qualifications, maintaining accurate credentialing records, tracking expirations, and ensuring compliance with organizational policies and applicable healthcare regulations. The ideal candidate has previous experience in healthcare credentialing, medical staff services, or provider enrollment.Key ResponsibilitiesProcess initial credentialing and recredentialing applications for physicians, advanced practice providers, and other healthcare professionals.Verify professional licenses, education, training, board certifications, work history, malpractice coverage, and other required credentials.Conduct primary source verification and review supporting documentation for accuracy and completeness.Maintain and update provider credentialing files and databases.Monitor expiration dates for licenses, certifications, insurance, and other required documents.Follow up with providers and internal departments to obtain missing or updated documentation.Ensure credentialing records meet applicable regulatory, accreditation, and organizational requirements.Assist with provider enrollment and related administrative processes as assigned.Prepare credentialing files for committee review, audits, and compliance reviews.Communicate with providers, medical staff offices, insurance representatives, and internal stakeholders regarding application status.Maintain strict confidentiality of provider and organizational information.Meet established deadlines and productivity standards while managing multiple credentialing files.Required QualificationsHigh school diploma or equivalent required; associate or bachelor's degree preferred.Previous experience in healthcare credentialing, medical staff services, provider enrollment, or a related administrative role preferred.Knowledge of credentialing procedures, primary source verification, and provider documentation requirements.Familiarity with CAQH, NPI Registry, PECOS, state medical license verification, or credentialing databases is preferred.Proficiency in Microsoft Office and electronic recordkeeping systems.Strong organizational skills and exceptional attention to detail.Excellent written and verbal communication skills.Ability to manage multiple priorities and maintain confidential records.