
healthcare credentialing specialist
1 day ago
About the Role
We are seeking a Healthcare Credentialing Specialist with strong experience in managing provider enrollment, credentialing, and compliance with regulatory guidelines. The ideal candidate will have a keen eye for detail, excellent communication skills, and the ability to work collaboratively with providers, payers, and internal teams.
Key Responsibilities
- Manage the full-cycle credentialing and re-credentialing process for healthcare providers.
- Verify and maintain provider documentation, licenses, certifications, and affiliations.
- Coordinate with insurance companies, hospitals, and healthcare organizations for provider enrollment.
- Ensure compliance with NCQA, CMS, and other regulatory requirements.
- Maintain accurate and up-to-date records in credentialing databases.
- Communicate effectively with providers regarding application status, missing information, or required updates.
- Support audits, reporting, and quality improvement initiatives.
- Communicate effectively with providers regarding application status, missing information, or required updates.
- Maintain accurate and up-to-date records in credentialing databases.
- Ensure compliance with NCQA, CMS, and other regulatory requirements.
- Coordinate with insurance companies, hospitals, and healthcare organizations for provider enrollment.
- Verify and maintain provider documentation, licenses, certifications, and affiliations.
Qualifications
- Minimum 1 year of hands-on experience in healthcare credentialing or provider
- Familiarity with credentialing software/systems (CAQH, NPPES, PECOS, etc.).
- Excellent organizational and documentation skills.
- Familiarity with credentialing software/systems (CAQH, NPPES, PECOS, etc.).
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