Credentialing Specialist
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What you'll do
- Coordinate the initial credentialing, re-credentialing, and privileging processes for healthcare providers.
- Verify provider qualifications, including licenses, certifications, education, training, work history, malpractice coverage, and professional references.
- Prepare and submit credentialing applications to insurance payers and regulatory agencies.
- Monitor provider licenses, certifications, DEA registrations, and other required credentials for expiration and renewal.
- Maintain accurate provider records in credentialing databases and document management systems.
- Ensure compliance with NCQA, Joint Commission, CMS, state, and organizational credentialing requirements.
- Conduct primary source verification and maintain supporting documentation.
- Track application statuses and follow up with providers, payers, and credentialing entities as needed.
- Assist with audits, accreditation reviews, and regulatory reporting requirements.
- Respond to provider and stakeholder inquiries regarding credential status and requirements.
- Generate reports and analyze credentialing data to support operational and compliance objectives.
- Collaborate with provider enrollment, contracting, compliance, and operations teams.
What they're looking for
- High School diploma or equivalent
- At least 2 years of experience in credentialing, provider enrollment, healthcare administration, or related experience
Nice to have
- Certified Provider Credentialing Specialist (CPCS) certification.
- Experience with CAQH, PECOS, NPPES, and provider enrollment systems.
- Familiarity with NCQA, Joint Commission, CMS, and state licensing requirements.
- Experience in a medical group, health plan, or healthcare organization.
Summarised by NextRaise from the employer’s description, which follows in full below.
Full description from employer
Where people get better at life!
Join us in our mission to make a difference and shape a more inclusive future.
We are searching for a Credentialing Specialist to join our Center Health Care Team!
This role supports healthcare providers by managing credentialing and re-credentialing activities, maintaining accurate records, and coordinating with insurance payers, licensing boards, and internal stakeholders.
Responsibilities:
Coordinate the initial credentialing, re-credentialing, and privileging processes for healthcare providers.
Verify provider qualifications, including licenses, certifications, education, training, work history, malpractice coverage, and professional references.
Prepare and submit credentialing applications to insurance payers and regulatory agencies.
Monitor provider licenses, certifications, DEA registrations, and other required credentials for expiration and renewal.
Maintain accurate provider records in credentialing databases and document management systems.
Ensure compliance with NCQA, Joint Commission, CMS, state, and organizational credentialing requirements.
Conduct primary source verification and maintain supporting documentation.
Track application statuses and follow up with providers, payers, and credentialing entities as needed.
Assist with audits, accreditation reviews, and regulatory reporting requirements.
Respond to provider and stakeholder inquiries regarding credential status and requirements.
Generate reports and analyze credentialing data to support operational and compliance objectives.
Collaborate with provider enrollment, contracting, compliance, and operations teams.
Requirements:
High School diploma or equivalent
At least 2 years of experience in credentialing, provider enrollment, healthcare administration, or related experience
Experience Preferred:
Certified Provider Credentialing Specialist (CPCS) certification.
Experience with CAQH, PECOS, NPPES, and provider enrollment systems.
Familiarity with NCQA, Joint Commission, CMS, and state licensing requirements.
Experience in a medical group, health plan, or healthcare organization.
At The Center for Disability Services, we don't just accept difference—we celebrate it, support it, and thrive on it for the benefit of our employees and the people we support. We are proud to be an Equal Opportunity Employer and do not discriminate against any protected class of job applicant or employee in our employment practices.
Compensation Range:
$26.00 - $28.00Benefits:
- Medical Insurance
- Dental Insurance
- Vision Insurance
- 401(k) Retirement Savings Plan
- EAP (Employee Assistance Program)
- Generous Paid Time Off (PTO)
- Tuition Reimbursement
- Early Access to Pay with RAIN
- Public Service Loan Forgiveness (PSLF)
Company
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