Credentialing Specialist

Responsibilities

• Maintain complete and up-to-date provider files by organizing credentialing documentation and updating records as new information is received.
• Track expiration dates for licenses, certifications, health documents, and continuing education items to help ensure renewals are completed on time.
• Prepare and submit initial credentialing and reappointment applications, then follow up proactively to move each file toward completion.
• Examine incoming applications and supporting materials for accuracy, consistency, and missing information before processing.
• Communicate with providers to obtain required documents and confirm that all credentialing records remain current.
• Conduct primary and secondary verifications to validate provider qualifications and supporting credentialing data.
• Respond to requests from hospitals and health plans by supplying necessary credentialing information for provider files.
• Protect sensitive records by following confidentiality standards and secure document handling practices.
• Partner with the credentialing manager to address file discrepancies, application delays, and other credentialing-related issues.

Requirements

• Prior experience in provider credentialing, physician credentialing, or a closely related healthcare administrative function.
• Working knowledge of credentialing workflows, including initial appointments, reappointments, and verification activities.
• Ability to manage multiple applications and renewal timelines with strong attention to detail and accuracy.
• Experience reviewing documentation for completeness and resolving missing or inconsistent information.
• Strong written and verbal communication skills for working with providers, hospitals, health plans, and internal teams.
• Understanding of confidentiality expectations and secure handling of sensitive provider records.
• Proficiency with standard office systems and databases used to maintain credentialing documentation such as CredentialStream.
• Familiarity with re-credentialing application processes and ongoing provider file maintenance.

Qualifications

The ideal candidate will be detail-oriented, organized, and comfortable working directly with providers, health plans, and internal stakeholders to keep credentialing files current.