Credentialing Specialist

Job Description

Job Description

Credentialing Specialist is responsible for coordinating and managing all aspects of provider credentialing, recredentialing, privileging, and payer enrollment activities to ensure compliance with organizational policies, regulatory requirements, accreditation standards, and payer guidelines. This position maintains accurate and confidential provider credentialing records; performs primary source verification of licensure, certifications, education, training, and other professional qualifications; and monitors ongoing compliance with credentialing requirements, including license and certification renewals.

 

The Credentialing Specialist prepares and submits credentialing and enrollment applications for healthcare providers, tracks application progress, and serves as a liaison between providers, payers, regulatory agencies, and internal departments to ensure timely approval and network participation. The role also supports medical staff credentialing processes, Credentials Committee activities, practitioner verification requests, and coordination of student and resident credentialing activities. Strong organizational skills, attention to detail, regulatory knowledge, and the ability to manage multiple priorities in a fast-paced healthcare environment are essential for success in this position.

Schedule:

This is a regular, full-time position, 8 hours per day, M-F with occasional evening or weekend assignments.

Educational Requirements:

Required: High School diploma or equivalent.

Encouraged for professional development: Certified Provider Credentialing Specialist (CPCS).

Experience:

Required: 5-7 years office experience.

Preferred: Facility Provider Credentialing experience and training in medical terminology.

Skills, Knowledge, Abilities:

Ability to operate any office equipment including personal computer using a variety of software applications (Word/Excel), fax machine, and any type of audio/visual equipment.

Thorough knowledge of modern office practices, procedures, including file organization and record-keeping skills. 

Be able to type a minimum of 55 words per minute.

Excellent written, verbal, interpersonal, and organizational skills beyond the normal scope of secretarial work. Must be able to handle multiple tasks and meet timelines.

Ability to work independently with minimal supervision. 

Ability to maintain confidentiality and communicate diplomatically with personnel, providers, visitors, and the general public.