Credentialing Specialist

General Information:

  Schedule: Monday through Friday, from 8am to 430pm

 

Compensation We Offer   

 

• The initial compensation for this position ranges from $23 to $28.23 Per Hour, depending on experience, location and internal equity considerations 

 

Possible Additional Compensation (may vary based on position eligibility) 

 

 

• Possible Bilingual Differentials: Up to 7.5% for qualifying direct-service roles; up to $80.00/month flat fee for qualifying non-direct service roles. 

 

Benefits We Offer  

 

• Benefits Eligibility starts on day ONE 

• We provide a robust benefits package which includes medical, dental, vision, See our Benefits Page HERE. 

• 401K Employer Match up to 4% 

• Competitive Time Off Plans 

 

 

Must meet eligibility requirements based on employment status 

Overview:

The Credentialing Specialist is responsible for ensuring that all healthcare professionals within the
organization are properly credentialed and compliant with state, federal, and organizational regulations. This role involves verifying the qualifications of the workforce members, maintaining accurate and up-todate records, and ensuring timely re-credentialing. The Credentialing Specialist plays a crucial role in supporting the overall quality of care provided by the organization.

Responsibilities:

• Conducts primary source verifications of licensure, board certifications, education, and work
  history.
• Tracks and manages re-credentialing timelines to ensure timely renewal and compliance.
• Maintains and updates credentialing databases and records with accuracy and confidentiality.
• Communicates with providers and internal departments regarding credentialing status and
  documentation needs.
• Collaborates with compliance and quality teams to ensure adherence to standards (e.g., NCQA,
  CMS, The Joint Commission).
• Responds to credentialing-related inquiries and audit requests.
• Assists in preparing files for credentialing committee review and maintain records of decisions.

Qualifications:

• Associate degree (AA/AS) in healthcare administration, business, or a related field and (2) two or
  more years of relevant experience required; or equivalent combination of education and
  experience to include:
• Minimum of (2) two years of experience in credentialing within a healthcare or managed care
  setting
• Working knowledge of credentialing standards and regulatory bodies such as NCQA, CMS, and The Joint Commission
• Experience using credentialing databases or platforms such as CAQH, Verity, or MD-Staff
• Proficiency in Microsoft Office applications including Excel, Outlook, and Word
• Strong organizational, analytical, and interpersonal skills
• Ability to handle sensitive data with discretion and confidentiality
• Willingness to obtain Certified Provider Credentialing Specialist (CPCS) certification within 1–2
  years if not already help