Credentialing Specialist

About This Role

This Credentialing Specialist role supports provider readiness, compliance, and operational success by ensuring that providers, clinicians, facilities, and payer records are properly credentialed and maintained. The position helps the company's teams deliver quality, integrated care while meeting payer, licensing, regulatory, and accreditation requirements.

Responsibilities

• Prepare, submit, and track credentialing and re-credentialing applications for providers, clinicians, facilities, private payers, managed care organizations, and other applicable entities
• Support credentialing processes for physicians, nurse practitioners, physician assistants, clinical therapists, and other healthcare professionals
• Collect, verify, and maintain provider documentation, including licenses, certifications, malpractice coverage, DEA/NPI information, education, training, work history, and other required records
• Ensure credentialing files are complete, accurate, current, and compliant with federal, state, payer, licensing, and accreditation standards
• Monitor expiration dates and proactively follow up on renewals for licenses, certifications, payer enrollments, insurance, and other required documentation
• Maintain accurate credentialing databases, trackers, rosters, and provider records to support reporting, audit readiness, and timely updates
• Communicate regularly with providers, internal departments, leadership, payers, and external agencies to obtain required information and resolve credentialing or enrollment issues
• Assist with payer enrollment, provider roster updates, and follow-up needed to support timely billing and provider activation
• Maintain NHSC-related information and documentation, as applicable
• Support internal audits, compliance reviews, and process improvement efforts related to credentialing and provider enrollment
• Perform other duties as identified or assigned

Requirements

• High school diploma or equivalent required; associate or bachelor
• At least 1 year of administrative, credentialing, healthcare, compliance, payer enrollment, or related experience required
• 1
• Strong attention to detail and accuracy when reviewing, entering, and maintaining information
• Excellent written and verbal communication skills with the ability to work professionally with providers, leaders, payers, and internal teams
• Strong organizational and time management skills with the ability to manage multiple deadlines and follow-up items
• Ability to work independently while also collaborating with cross-functional teams
• Proficiency with Microsoft Office products, including Outlook, Word, and Excel
• Ability to use computers, web-based systems, payer portals, credentialing platforms, and other online tools