Job Description

Position Overview

The Credentialing Specialist supports the credentialing function by performing administrative and operational tasks related to employee licensure, certifications, and payer credentialing processes. This role ensures that required documentation is accurate, up to date, and processed in accordance with established procedures, regulatory requirements, and organizational standards.

This position follows defined workflows and works under the direction of the Credentialing Manager.

Key Responsibilities

• Review onboarding and credentialing documentation for completeness and accuracy.
• Prepare and submit credentialing and recredentialing applications for providers and facilities.
• Track application status and maintain detailed logs of pending and completed submissions.
• Conduct follow-up with payers, providers, and internal stakeholders regarding application status.
• Monitor and notify providers of upcoming license, certification, and credential expirations.
• Perform primary source verification and registry checks in accordance with established requirements.
• Create and maintain CAQH profiles and ensure all data is accurate and current.
• Enter and maintain credentialing data in internal systems with a high level of accuracy.
• Assist with audits, roster reconciliations, and compliance-related reporting.
• Support onboarding and offboarding credentialing activities.
• Communicate credentialing status updates to appropriate stakeholders.

Operational Scope

• Performs work based on established procedures, guidelines, and workflows.
• Escalates issues, delays, or compliance concerns to the Credentialing Manager.

Knowledge, Skills, and Education

• High school diploma required; Associate's degree preferred.
• Prior healthcare or credentialing experience preferred.
• Working knowledge of CAQH and credentialing processes preferred.
• Strong attention to detail and organizational skills.
• Ability to manage multiple tasks and meet deadlines.
• Strong written and verbal communication skills.
• Proficiency in Microsoft Office and database systems.

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