Credentialing Specialist

Job Description

Job Description

Description:

Join our team and help ensure a high-quality provider network that supports exceptional patient care.
We are seeking a detail-oriented, organized, and motivated full-time Credentialing Specialist to play a key role in the credentialing and recredentialing of healthcare providers within our organization.

Position Overview

The Credentialing Specialist is responsible for performing and coordinating credentialing activities in accordance with organizational policies, accrediting bodies, and state and federal regulations. This role ensures providers meet all requirements to deliver care within our network and supports ongoing quality assurance initiatives.

Schedule

• Full-time, Monday through Friday with hybrid work opportunities. 
• Work hours typically fall between 7:00 a.m.–5:30 p.m.
• Occasional evenings or weekends may be required based on workload.

We offer a comprehensive benefits package , including:

• Paid Time Off (PTO), Paid Holidays, Sick Leave
• 401(K) with Company Match, with immediate vesting
• Medical, Dental, and Vision coverage
• Short- and Long-Term Disability
• Life, Accidental, and Hospital indemnity Insurance
• And more!

Key Responsibilities

• Process and track credentialing and recredentialing applications in a timely manner.
• Review provider files for accuracy, completeness, and compliance.
• Conduct primary source verification in accordance with UPA policies, federal and state regulatory agencies, and accrediting bodies such as CMS and NCQA.
• Support and document investigations as requested by the Credentials Committee or Medical Director.
• Prepare provider files for Credentials Committee review.
• Collaborate closely with Provider Contracting and Provider Enrollment to ensure efficient application workflows and timely turnaround.
• Maintain tracking of expirable items (licenses, malpractice coverage, certifications, etc.).
• Attend monthly Credentialing Committee meetings and act on resulting decisions.
• Maintain confidential credentialing files and electronic credentialing databases.
• Participate in departmental meetings, audits, and continuous improvement initiatives.
• Assist with site visits as required.
• Perform additional duties as assigned.

• High School Diploma or equivalent (Associate degree preferred).
• Minimum 3 years’ experience in a healthcare delivery environment or 1–2 years in credentialing.
• Strong communication skills, both written and verbal.
• Ability to work independently, meet deadlines, and manage multiple tasks.
• High attention to detail and strong organizational skills.
• Ability to maintain professionalism and strict confidentiality.
• Knowledge of CMS, NCQA, and other credentialing standards and regulations.
• Proficiency in Microsoft Word, Excel, and credentialing databases (e.g., Cactus).
• Ability to work collaboratively with a variety of individuals and adapt to changing workflows.

Preferred:

• CPCS (Certified Provider Credentialing Specialist) or CPMSM (Certified Professional Medical Services Management).
  If not certified, must obtain certification within one year of eligibility.

Physical Requirements

• Occasional standing, walking, or sitting.
• Occasional kneeling, crouching, or lifting up to 25 pounds.

Travel

• Occasional local travel for meetings, training, and site visits.
• Some overnight travel may be required.