Credentialing Specialist (22772)

Credentialing Specialist

Position Type: Full Time Category: Managed Care Insurance

Location: 2537 Golden Bear Dr, Carrollton, TX 75006

Schedule: Full-time role with standard business hours

Reports to: Director, Network Strategy & Operations

Compensation: $60,000 to $70,000

What We Offer You

• Competitive pay
• Performance-based bonus opportunities
• Comprehensive health, dental, and vision insurance
• Additional supplemental benefits (life insurance, disability, accident, etc.)
• 401(k) with company match
• Generous paid time off (PTO/Sick)
• Clear career growth and advancement opportunities
• A supportive and vibrant company culture
• Many more employee perks and benefits

Job Summary

The Credentialing Specialist manages the full lifecycle of provider and facility credentialing for Skilled Nursing Facilities (SNFs), Home Health Agencies, ancillary providers, and individual practitioners. This role ensures all providers meet regulatory, accreditation, and payer enrollment requirements while maintaining accurate, compliant, and up-to-date credentialing records. The Credentialing Specialist partners closely with providers, payors, regulatory agencies, and internal teams to support timely onboarding, recredentialing, and ongoing compliance across the organization.

Qualifications

• Minimum 3 years of credentialing experience (providers, facilities, ancillary services)
• Required experience credentialing for Home Health and Skilled Nursing Facilities (SNFs)
• Knowledge of NCQA, CMS, and Joint Commission standards
• Proficiency in Microsoft Office (Outlook, Excel, Word, Access)
• Strong understanding of credentialing processes, medical terminology, and payer types
• Ability to maintain HIPAA compliance and confidentiality
• Strong communication, organizational, and time-management skills
• Ability to manage high-volume workloads and meet deadlines

Preferred Qualifications

• CPCS certification (or willingness to obtain within 2 years)
• Experience with full-cycle credentialing (CAQH, verifications, privileging, recredentialing)
• Experience with CAQH, PECOS, NPPES, and payer enrollment portals
• Experience credentialing physicians, allied health providers, and facilities (SNF, ASC, Home Health)
• Strong problem-solving and follow-up skills

Essential Functions

• Manage end-to-end credentialing and provider enrollment processes
• Perform primary source verification in compliance with accreditation standards
• Track provider licensure, certifications, DEA, malpractice insurance, and other credentials
• Monitor recredentialing cycles and ensure timely renewals
• Serve as liaison between providers, payors, and internal stakeholders
• Support credentialing committee preparation and documentation
• Maintain accurate credentialing records and generate reporting metrics
• Support provider and facility onboarding
• Ensure compliance with regulatory, accreditation, and payer requirements
• Assist with additional duties and projects as assigned

We are an Equal Opportunity Employer. We offer an excellent benefit plan to include 401(k) with match, CEU reimbursement, vacation, sick time, holidays, medical, dental, and supplemental insurance plans, as well as a highly competitive compensation package.