Credentialing Specialist

Job Description

Job Description

Position Summary

The Medical Credentialing Specialist is responsible for preparing, submitting, and maintaining enrollment, credentialing, and recredentialing documentation for physicians and other healthcare providers. This role ensures that healthcare professionals meet the necessary qualifications to provide care, verifying and assessing credentials to ensure compliance with industry standards and regulatory requirements .​

Key Responsibilities

Prepare and submit credentialing applications to payers.

Verify licensure, education, and training of providers.

Maintain accurate and complete provider files.

Monitor and track credentialing status for providers.

Ensure compliance with accreditation standards, regulatory requirements, and payer credentialing guidelines, such as NCQA, CAQH, Joint Commission, and CMS regulations .

Conduct audits and reviews of credentialing files to ensure accuracy, completeness, and compliance with credentialing standards and policies.

Identify opportunities for process improvements and efficiencies in the credentialing process.​

Qualifications

High school diploma or equivalent; associate degree in healthcare or business administration preferred .

Minimum of 2 years of experience in medical credentialing or a related field.

Knowledge of credentialing procedures, accreditation standards, and regulatory requirements.

Proficiency in Microsoft Office suite and credentialing software systems.

Strong attention to detail and accuracy in data entry and record-keeping.

Excellent communication and interpersonal skills, with the ability to interact effectively with providers and stakeholders.

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