Credentialing Specialist

Overview

Credentialing Specialists are responsible for confirming the licensing, training, and certification status of licensed independent practitioners, advanced practice professionals, and other healthcare workers. The role focuses on making sure providers and related services comply with federal and state regulations, along with NCQA quality standards. This position is fully remote.

Responsibilities

• Gather confidential, accurate information from primary sources to support customer decisions regarding practitioners and providers for health plans, hospitals, surgery centers, and other healthcare organizations.
• Work directly with health plans, government bodies, practitioners/providers, and customers as part of the credentialing process.
• Review, maintain, and process initial credentialing and re-credentialing files, while helping manage workflow issues tied to those files.
• Enter practitioner/provider information into the credentialing system and ensure all data is entered according to established standards.
• Complete initial and re-credentialing applications within required time limits.
• Carry out primary source verification in line with customer requirements and industry expectations.
• Protect the confidentiality and accuracy of all credentialing program activities and records.
• Handle administrative follow-up tasks and other essential support functions related to credentialing.
• Read, interpret, and communicate primary-source information promptly while applying current state, federal, and accreditation requirements to verification work.

Requirements

• Hands-on experience using primary source verification databases; familiarity with credentialing software or relational databases such as Access is important.
• Strong organizational ability and a detail-oriented working style.
• Excellent verbal and written communication skills.
• Strong customer service mindset and the ability to follow up effectively.
• Capability to stay organized and work efficiently in a busy, fast-moving environment.
• Recent, direct experience in healthcare credentialing within a hospital, CVO, or similar setting where regulatory and policy compliance is critical.
• Experience with primary source verification is required, including the ability to discuss the databases used for PSV.
• CPCS certification from NAMSS is preferred but not mandatory.

Perks

• Fully remote work arrangement.

Additional Information

This role is focused on safeguarding the integrity of the credentialing process while supporting decision-making for healthcare organizations. The compensation range for this position is USD 20.00 to USD 24.00 per hour.