Credentialling Specialist

<p><strong>About the Role</strong></p> <p>We are seeking a detail-oriented <strong>Credentialing Specialist</strong> with <strong>3+ years of experience</strong> to join our team. This role is responsible for managing the end-to-end credentialing and re-credentialing process for providers, ensuring compliance with regulatory, payer, and accreditation standards. The ideal candidate has strong organizational skills, a keen eye for detail, and experience navigating credentialing databases and payer enrollment systems.</p> <p><strong>Key Responsibilities</strong></p> <ul> <li>Process initial credentialing and re-credentialing applications for physicians, nurse practitioners, and other healthcare providers</li> <li>Verify provider credentials, including licenses, education, board certifications, malpractice history, and work history through primary source verification (PSV)</li> <li>Maintain accurate and up-to-date provider files in credentialing databases MD-Staff</li> <li>Coordinate with payers to complete provider enrollment and ensure timely reimbursement eligibility</li> <li>Track expiring licenses, certifications, and insurance to ensure continuous compliance</li> <li>Prepare credentialing files for committee review and present findings as needed</li> <li>Ensure compliance with NCQA, URAC, CMS, Joint Commission, and state/federal regulations</li> <li>Respond to internal and external inquiries regarding provider credentialing status</li> <li>Maintain confidentiality of sensitive provider information in accordance with HIPAA</li> <li>Identify and resolve discrepancies in credentialing files in a timely manner</li> <li>Support audits and provide documentation as requested</li> </ul> <p><strong>Qualifications</strong></p> <ul> <li><strong>3+ years</strong> of credentialing experience in a healthcare, managed care, or hospital setting</li> <li>Bachelor's degree preferred</li> <li>Strong knowledge of credentialing standards (NCQA, URAC, CMS) and primary source verification processes</li> <li>Experience with credentialing software/databases (CAQH, MD-Staff)</li> <li>Familiarity with payer enrollment processes (Medicare, Medicaid, commercial insurers)</li> <li>Excellent attention to detail and organizational skills</li> <li>Strong written and verbal communication skills</li> <li>Ability to manage multiple priorities and meet deadlines in a fast-paced environment</li> <li>Proficiency in Microsoft Office (Excel, Word, Outlook)</li> </ul> <p><strong>Preferred Skills</strong></p> <ul> <li>Experience with delegated credentialing audits</li> <li>Knowledge of state-specific licensing requirements</li> <li>Prior experience supporting medical staff committees or credentialing committees</li> </ul> <p> </p>