Credentialing Specialist

Please login or register as jobseeker to apply for this job.

TYPE OF WORK

Any

SALARY

$500 - $1000 USD/Month Based on Exp.

HOURS PER WEEK

40

DATE UPDATED

Aug 7, 2026

JOB OVERVIEW

Job Summary

The Credentialing Specialist will manage, verify, and maintain the professional licenses, certifications, and insurance network enrollments for healthcare client accounts. This role acts as a primary source verification agent, ensuring that all healthcare providers meet strict regulatory, state, federal, and payer compliance requirements. The ideal candidate is highly organized, detail-oriented, and proficient at navigating insurance applications and government portals.

Core Responsibilities

Primary Source Verification: Validate provider licensures, certifications, board credentials, education, and work history.
Application Processing: Complete and submit high-volume enrollment applications for government (Medicare, Medicaid) and commercial payers.

Database Maintenance: Update and maintain precise data fields across CAQH, PECOS, NPPES, and internal software.

Expiration Tracking: Proactively monitor provider expiration dates for DEA, state licenses, and malpractice insurance.
Discrepancy Resolution: Identify potential onboarding delays, research missing file documentation, and resolve issues.

Payer Follow-Up: Contact Managed Care Organizations (MCOs) and commercial plans regularly to track application statuses.

Audit Support: Assist in preparing required provider files and scoring checklists for accreditation reviews and audits.
Client Communication: Serve as a primary point of contact for providers, medical staff offices, and client leadership.

Required Skills & Qualifications
Education: High school diploma or equivalent required; Associate or Bachelor's degree preferred.

Experience: Minimum 1–3 years of direct healthcare credentialing or medical provider enrollment experience.

Technical Skills: Proficiency using specialized credentialing software (Credentialing Spectrum) and Google Sheets, Google Drive, FrontAPP

Regulatory Knowledge: Solid understanding of NCQA, Joint Commission, CMS, and state licensing board requirements.

Data Integrity: Extreme attention to detail with an exceptionally low error rate in high-volume data entry.

Communication: Clear, professional verbal and written communication skills for interacting with providers and insurance companies.

Confidentiality: Demonstrated capability to securely manage and process highly sensitive, confidential personal data.

Preferred Certifications
Certified Provider Credentialing Specialist (CPCS) through NAMSS.
Certified Professional Medical Services Management (CPMSM).

SKILL REQUIREMENT
Healthcare Documentation Credentialing
VIEW OTHER JOB POSTS FROM:
SHARE THIS POST
facebook linkedin
  BENCHMARKS  
Loading Time: Base Classes  0.0008
Controller Execution Time ( Jobseekers / Job )  0.0179
Total Execution Time  0.0193
  GET DATA  
No GET data exists
  MEMORY USAGE  
1,497,768 bytes
  POST DATA  
No POST data exists
  URI STRING  
jobseekers/job/Credentialing-Specialist-1705103
  CLASS/METHOD  
jobseekers/job
  DATABASE:  onlinejobs (Jobseekers:$db)   QUERIES: 13 (0.0122 seconds)  (Hide)
0.0004   SELECT *
                                FROM exrates
                                WHERE rate_name = 'USD-PHP' 
0.0005   SELECT *
FROM `employer_jobs`
WHERE `job_id` = 1705103
 LIMIT 1 
0.0010   SELECT *
FROM `employers`
WHERE `employer_id` = 958215
 LIMIT 1 
0.0008   SELECT COUNT(*) AS `numrows`
FROM `t_thread` `t`
LEFT JOIN `t_thread_misc` `misc` ON `t`.`id` = `misc`.`thread_id`
WHERE `t`.`job_id` = 1705103
AND `misc`.`id` IS NULL 
0.0004   SELECT e.business_name, e.logo, e.website, e.rebill_date, e.date_added member_date, hits, DATEDIFF('2026-08-09',ej.date_added) duration_days, DATEDIFF('2026-08-09',e.rebill_date) duration_rebill, ej.*, e.deactivate FROM employers e, employer_jobs ej WHERE e.employer_id = ej.employer_id AND
                                   ((e.user_level >= '500' AND ej.date_added <= e.rebill_date)
                                   OR e.employer_id = '' OR (ej.date_approved <> '2000-01-01' and DATEDIFF('2026-08-09',ej.date_added) <= 14 ))
                                   AND e.deactivate != 1 AND ej.deleted = 0 AND job_id = '1705103' 
0.0003   SELECT *
FROM `employer_jobs_skills` `ejs`
LEFT JOIN `skills_categories` `sc` ON `ejs`.`skill_id` = `sc`.`id`
WHERE `job_id` = 1705103 
0.0007   UPDATE employer_jobs SET hit_counts = '***Aug-07-2026=87***Aug-08-2026=453***Aug-09-2026=1' WHERE job_id= '1705103'  
0.0006   UPDATE employer_jobs SET monthly_hits = '***Aug-2026=541' WHERE job_id= '1705103'  
0.0008   SELECT date_sent FROM jobseeker_sent_emails WHERE jobseeker_id = '' AND job_id = '1705103' AND status LIKE 'sent%' ORDER BY id DESC  
0.0003   SELECT *
FROM `employer_jobs_skills` `ejs`
LEFT JOIN `skills_categories` `sc` ON `ejs`.`skill_id` = `sc`.`id`
WHERE `job_id` = 1705103 
0.0011   SELECT COUNT(*) AS `numrows`
FROM `employer_jobs`
WHERE `employer_id` = '958215'
AND `date_added` >= '2022-06-08' 
0.0004   select * from teasers 
0.0048   SELECT * FROM skill_categories WHERE skill_cat_id='' 
  HTTP HEADERS  (Show)
  SESSION DATA  (Show)
  CONFIG VARIABLES  (Show)