Senior Credentialing Specialist

Job Description

Job Description

Senior Credentialing Specialist

Pay Rate: $43.27–$48.08 per hour
Schedule: Full-Time
Location: On-Site – Pompano Beach, FL
Reports To: Chief Operating Officer (COO)

About the Role

We are seeking an experienced and detail-oriented Senior Credentialing Specialist to manage and oversee clinical credentialing operations. This position is responsible for ensuring that healthcare providers meet all applicable credentialing, licensing, regulatory, and compliance requirements before and throughout their engagement with the organization.

The Senior Credentialing Specialist will manage the full credentialing and recredentialing process for a diverse population of healthcare professionals, including Nurse Practitioners, Registered Nurses, Licensed Practical Nurses, and other clinical providers.

The ideal candidate has strong knowledge of healthcare credentialing requirements, exceptional attention to detail, and the ability to manage multiple providers, deadlines, and compliance requirements in a fast-paced healthcare environment.

Key Responsibilities

• Manage the full lifecycle of clinical credentialing and recredentialing for healthcare providers.
• Verify provider qualifications, including licenses, certifications, education, training, work history, malpractice coverage, professional references, and other required credentials.
• Conduct primary source verification and maintain accurate, complete, and audit-ready credentialing files.
• Manage credentialing requirements for Nurse Practitioners, Registered Nurses, Licensed Practical Nurses, and other clinical professionals.
• Monitor provider licenses, certifications, registrations, malpractice insurance, and other time-sensitive credentials.
• Track expiration dates and proactively initiate renewal processes before credentials expire.
• Identify, investigate, and resolve credentialing discrepancies, gaps, and compliance concerns.
• Coordinate provider enrollment and credentialing activities with health plans, payers, healthcare organizations, and external partners.
• Guide clinical providers through credentialing, onboarding, and related compliance requirements.
• Partner with Clinical Operations, Human Resources, Compliance, and leadership to ensure providers are appropriately credentialed and cleared before providing patient care.
• Maintain accurate provider information and credentialing documentation within internal systems and databases.
• Develop and improve credentialing workflows, processes, checklists, and standard operating procedures.
• Monitor credentialing timelines, productivity, and performance metrics to ensure deadlines and requirements are consistently met.
• Support internal and external audits by maintaining organized and readily accessible credentialing documentation.
• Stay current on applicable healthcare regulations, credentialing standards, payer requirements, and state-specific licensing requirements.
• Identify opportunities to improve efficiency and reduce credentialing delays.
• Serve as a subject-matter expert and resource regarding clinical credentialing requirements and processes.
• Perform additional credentialing and compliance-related duties as assigned.

Qualifications

• Minimum of 7 years of clinical credentialing experience, preferably within a healthcare organization, medical group, health plan, staffing organization, or similar environment.
• Strong understanding of the provider credentialing and recredentialing lifecycle.
• Experience conducting primary source verification and ongoing credential monitoring.
• Experience credentialing a variety of healthcare professionals, including Nurse Practitioners, Registered Nurses, Licensed Practical Nurses, and other clinical providers.
• Working knowledge of healthcare licensing, certifications, malpractice insurance, professional references, education verification, and provider qualification requirements.
• Experience with payer or health plan credentialing and enrollment processes strongly preferred.
• Familiarity with CAQH, credentialing databases, provider management systems, and other healthcare credentialing platforms.
• Strong understanding of healthcare compliance requirements and credentialing standards.
• Ability to research, interpret, and apply licensing and credentialing requirements.
• Exceptional attention to detail and accuracy when handling sensitive provider and compliance information.
• Strong organizational and time-management skills.
• Ability to manage multiple providers, deadlines, and priorities simultaneously.
• Excellent written and verbal communication skills.
• Ability to communicate effectively with healthcare providers, internal stakeholders, health plans, and external partners.
• Strong problem-solving skills with the ability to independently research and resolve credentialing issues.
• Ability to work independently while collaborating effectively with Clinical Operations, Human Resources, Compliance, and leadership.
• Experience developing or improving credentialing processes, workflows, and standard operating procedures is preferred.

Compensation & Benefits

• Hourly Pay: $43.27–$48.08 per hour
• Medical, Dental, and Vision Insurance
• Life and AD&D Insurance
• Health Benefit Program
• Paid Vacation and Sick Time
• Paid Holidays
• Company-Provided Equipment

Work Environment

This is a full-time, on-site position in Pompano Beach, Florida. The successful candidate should be comfortable working in a professional, fast-paced healthcare environment while managing confidential information, multiple provider files, and time-sensitive credentialing requirements.

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