Provider Payer Credentialing Specialist

Job Description

Job Description

Date posted: July 6, 2026

Pay: $18.00 - $25.00 per hour

Job description:

Overview

We are seeking a dynamic and detail-oriented Provider Credentialing/Contract Specialist to join our healthcare team. In this vital role, you will oversee the credentialing and contracting processes for healthcare providers, ensuring compliance with industry standards and regulatory requirements. Your expertise will help facilitate seamless provider onboarding, maintain accurate records, and support the organization’s commitment to delivering high-quality care. This position offers an exciting opportunity to contribute to a mission-driven environment dedicated to improving patient outcomes through rigorous provider management.

Responsibilities

• Manage the end-to-end provider credentialing process, including verifying licensure, certifications, and clinical qualifications in accordance with industry standards such as NCQA (National Committee for Quality Assurance) and JCAHO (Joint Commission).
• Maintain and update provider databases using healthcare software applications, ensuring data accuracy and regulatory compliance.
• Review and process provider applications for network participation, including contract negotiations and renewals aligned with healthcare laws and CMS (Centers for Medicare & Medicaid Services) regulations.
• Ensure adherence to state healthcare regulations, CMS policies, and health insurance requirements during credentialing and contracting activities.
• Collaborate with internal teams to prepare documentation supporting accreditation standards and regulatory audits related to provider credentials.
• Monitor contract compliance, track key contractual milestones, and assist in resolving discrepancies or issues related to provider agreements.
• Stay informed about evolving healthcare policies, CMS updates, and industry best practices to continuously improve credentialing workflows.

Requirements

• Proven experience in managed care settings with a strong understanding of health regulation policies including CMS guidelines, NCQA standards, and JCAHO accreditation requirements.
• Medical office experience or background working within healthcare environments is highly preferred.
• Knowledge of health insurance processes, including claims adjudication and payer requirements.
• Familiarity with healthcare software applications used for credentialing, contract management, and database management systems.
• Strong understanding of medical terminology, state healthcare regulations, and CMS regulatory compliance standards.
• Demonstrated ability to manage multiple projects simultaneously while maintaining attention to detail.
• Excellent communication skills with the ability to collaborate effectively across departments.

Join us as a Provider Credentialing/Contract Specialist if you’re passionate about ensuring providers meet rigorous standards that directly impact patient care quality! Your expertise will support our organization’s mission of delivering exceptional healthcare services while advancing your career in a fast-paced, rewarding environment dedicated to excellence in provider management.