Provider Credentialing & Licensing Specialist

Job Description

Job Description

Position Summary

The Provider Credentialing & Licensing Specialist owns end-to-end credentialing and licensing for physicians and advanced practice providers employed by our single-TIN medical groups. Many of these providers are transitioning from hospital employment to group practice and rely on this role to navigate credentialing, state licensing, and enrollment prerequisites for the first time. The Specialist performs NCQA-compliant primary source verification and file assembly, manages multi-state license and DEA applications, and keeps providers on track from offer acceptance through committee approval, directory listing, and payer enrollment readiness.

Key Responsibilities

Provider Credentialing

• Perform initial credentialing and re-credentialing for employed (single-TIN) providers in accordance with NCQA standards, delegated health plan requirements, and AMM policies.
• Conduct primary source verification (PSV) of licensure, DEA, board certification, education and training, work history, malpractice history, and sanctions/exclusions (NPDB, OIG/SAM, Medicare Opt-Out, state Medicaid).
• Assemble complete, audit-ready credentialing files and prepare them for Credentialing Committee review; track each file through approval, directory listing, and enrollment readiness.
• Collect and verify malpractice insurance certificates (COI) and tail coverage documentation before file completion.
• Manage expirable — licenses, DEA registrations, board certifications, COIs — with proactive renewal outreach.
• Maintain separation-of-duties and conflict-of-interest safeguards consistent with NCQA credentialing standards.

Provider Licensing

• Prepare, submit, and track state medical license applications and renewals as providers join or expand into new markets (CA, WA, HI, NY, NJ, GA).
• Manage DEA and state controlled-substance registrations, fingerprinting, and licensing board correspondence through approval.
• Guide newly employed physicians through licensing and credentialing prerequisites with clear checklists and one-on-one support sessions.
• Coordinate CAQH profile setup and attestation requirements with Provider Engagement and clinical onboarding staff.

Coordination, Tracking & Compliance

• Maintain the provider onboarding and credentialing status tracker; report status, aging, and blockers to leadership.
• Review intake packets for completeness (practice locations, TINs, licensure, malpractice/COI) before credentialing submission.
• Support delegated credentialing audits and health plan or regulatory audit preparation with organized, retrievable documentation.
• Partner with Provider Engagement, HR, health plans, and market leadership across states; contribute to credentialing SOPs and the team manual.

Required Qualifications

• 3+ years of provider credentialing experience with a medical group, IPA, MSO, CVO, or health plan.
• Working knowledge of NCQA credentialing standards and primary source verification requirements.
• Hands-on experience with state medical board licensing and DEA registration processes.
• Proficiency with CAQH ProView, NPPES, PECOS, and credentialing databases/software; strong Microsoft 365 and Excel skills.
• Proven ability to independently manage a high-volume pipeline with accuracy and follow-through in a remote or hybrid setting.
• High school diploma or equivalent.

Preferred Qualifications

• CPCS or CPMSM certification (NAMSS).
• Multi-state licensing experience; Washington, Hawaii, New York, New Jersey, or Georgia a plus.
• Experience in a delegated credentialing environment and supporting physicians transitioning from hospital employment to group practice.
• Associate or bachelor's degree.
• Bilingual (Korean or Spanish) a plus.

AMM BENEFITS

When you join AMM, you’re not just getting a job—you’re getting a benefits package that puts YOU first:

• Health Coverage You Can Count On : Full employer-paid HMO and the option for a flexible PPO plan .
• Wellness Made Affordable : Discounted vision and dental premiums to help keep you healthy from head to toe.
• Smart Spending : FSAs to manage healthcare and dependent care costs, plus a 401(k) to secure your future.
• Work-Life Balance : Generous PTO , 40 hours of sick pay , and 13 paid holidays to enjoy life outside of work.
• Career Development : Tuition reimbursement to support your education and growth.