Credentialing Specialist

Job Description

Job Description

We are seeking an experienced, highly organized, and detail-oriented Credentialing Specialist to join our Practice Operations team in Clinton Twp. This is a key position responsible for managing the credentialing, licensing, payer enrollment, hospital privileges, professional liability insurance, compliance tracking, and onboarding/offboarding processes for our healthcare providers. 

Must be based in Michigan as this position will be a hybrid/remote role.

The Credentialing Specialist plays an essential role in ensuring that physicians, advanced practice providers, and nursing professionals maintain all required credentials and remain eligible to practice across applicable locations, hospitals, networks, and insurance plans.

This position is ideal for someone who enjoys managing complex administrative processes, working independently, meeting deadlines, solving problems, and maintaining highly confidential information.

What You'll Do:

Credentialing & Compliance

Manage and maintain credentialing requirements for MD/DOs, PAs, NPs, and RNs, including:

• ACLS and BLS certifications
• Board certifications, including ABD, ABP, AOBD, ANCC, and NCCPA
• Annual board certification fees and CCP requirements
• CAQH profiles, including new profiles, quarterly updates, onboarding, offboarding, and document updates
• CLIA certificates for all locations
• CME funds and CME tracking
• Curriculum vitae (CV) maintenance
• Provider demographic and identifying information
• Driver's license information and expiration dates
• ECFMG documentation, as applicable
• Provider education and training records
• Influenza vaccination tracking
• Letters of recommendation
• TB testing and expiration tracking
• UPIN tracking, as needed
• W-9 documentation for CAQH

Licensing & Regulatory Compliance

Manage applications, renewals, documentation, and tracking for:

• Professional licenses for MD/DO, PA, NP, and RN providers
• Full and limited physician licenses
• Controlled substance licenses
• DEA licenses
• Individual and corporate NPI applications and updates
• MiPLUS applications and renewals
• HIPAA taxonomy codes
• Provider and organizational records
• Provider addresses and telephone numbers
• Facility addresses, telephone numbers, and fax numbers
• EIN applications and tracking
• Other regulatory and compliance documentation

Hospital Credentialing & Privileges

Coordinate hospital credentialing and medical staff requirements, including:

• Initial hospital appointments
• Hospital reappointments
• Appointment and reappointment letters
• Hospital privileges
• Hospital privilege grids and master lists
• Hospital staff dues
• Hospital login information
• Hospital credentialing documentation and deadlines
• Communication and follow-up with hospitals and medical staff offices

Payer & Network Credentialing

Manage provider participation and documentation requirements for insurance carriers and healthcare networks, including:

• Network applications
• Network credentialing and recredentialing
• Network payments and tracking
• Network appointment letters
• Payer documentation and deadlines
• Provider information required by billing and payer organizations
• Maintenance of payer and network records

Professional Liability Insurance

Manage professional liability insurance requirements, including:

• New PLI applications
• Policy renewals
• Claims and Notices of First Report
• Litigation documentation and tracking
• Certificates of Insurance (COIs)
• Distribution of COIs to CAQH, hospitals, and networks
• PLI tribute plan administration, as applicable
• Communication with insurance carriers and brokers
• Maintaining current insurance documentation

Provider Onboarding & Offboarding

Coordinate the credentialing and administrative components of provider onboarding and offboarding, including:

• New provider credentialing
• Collection and review of required documentation
• CAQH setup and maintenance
• License and certification verification
• NPI and payer enrollment
• Hospital credentialing
• Network credentialing
• Professional liability insurance requirements
• Provider database setup
• Location assignments
• Coordination with the Billing Manager
• Offboarding and termination of applicable credentials, payer relationships, hospital privileges, and accounts
• Communication and coordination with billing, management, and other departments

What Success Looks Like

The successful candidate will take ownership of the credentialing process and ensure that providers remain current, compliant, and eligible to practice.

You will:

• Maintain accurate and confidential provider and organizational records
• Proactively monitor expiration dates and renewal deadlines
• Prevent lapses in licenses, certifications, insurance, hospital privileges, and payer participation
• Maintain organized electronic and hard-copy files
• Develop and maintain effective credentialing tracking systems
• Ensure documentation is complete, accurate, and submitted on time
• Follow up consistently with providers, hospitals, insurance carriers, networks, government agencies, and professional organizations
• Identify upcoming deadlines and communicate them proactively
• Work closely with the Billing Manager and Practice Leadership
• Maintain strict confidentiality of sensitive provider and organizational information
• Support regulatory and compliance readiness
• Resolve credentialing and administrative issues efficiently
• Develop and maintain professional relationships with external organizations and vendors
• Independently manage multiple priorities, projects, and deadlines

What We're Looking For

Required Qualifications

• Minimum of 3 years of experience in medical credentialing, provider enrollment, healthcare administration, practice management, or a related field
• Strong knowledge of physician and advanced practice provider credentialing
• Experience with CAQH, NPI, DEA, state licensing, payer enrollment, hospital credentialing, and professional liability insurance
• Excellent organizational and time-management skills
• Exceptional attention to detail
• Ability to manage multiple providers, entities, deadlines, and projects simultaneously
• Excellent written and verbal communication skills
• Ability to handle confidential and sensitive information with discretion
• Proficiency with Microsoft Office and electronic document management systems
• Ability to work independently and exercise sound judgment
• Strong follow-up, problem-solving, and communication skills

Our Ideal Candidate

We are looking for someone who is:

• Highly organized and detail-oriented
• Proactive rather than reactive
• Dependable and accountable
• Comfortable managing multiple deadlines
• A strong communicator and relationship builder
• Discreet and trustworthy
• Able to work independently with minimal supervision
• Comfortable navigating complex credentialing and administrative requirements
• Skilled at identifying potential problems before they become issues
• Committed to accuracy, compliance, and excellent service

Why This Position Matters

Provider credentialing is critical to the successful operation of a healthcare organization. Accurate and timely credentialing ensures that providers are properly licensed, insured, credentialed, enrolled, and authorized to practice.

As a Provider Credentialing Specialist , you will serve as a central point of coordination between providers, practice leadership, billing, hospitals, insurance carriers, networks, regulatory agencies, and professional organizations.

Your work will directly help ensure that our providers and organizational entities remain current, compliant, and in good standing .

This is a high-responsibility position for an individual who takes pride in organization, accuracy, initiative, confidentiality, and follow-through.

If you are an experienced credentialing professional who enjoys taking ownership of complex processes and making sure every detail is handled correctly, we would like to hear from you.

Benefits:

• 401(k)
• Dental insurance
• Employee assistance program
• Employee discount
• Health insurance
• Health savings account
• Life insurance
• Paid time off
• Vision insurance