Credentialing Specialist

American Health Partners

. Maintain and load provider demographic information received via contracts, roster updates, and/or applications to the CVO .

Posted 11/4/2026full-timeRemote • Tennessee • United StatesMid-LevelSeniorWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in provider data management, credentialing processes, and quality assurance within the healthcare sector. Proficient in data extraction, reporting, and maintaining database integrity while ensuring compliance with departmental standards.

Highest-signal resume keywords

Credentialing ExperienceCVO Platforms ExperienceMedicare Advantage Plans KnowledgeData Management SkillsEffective Communication Skills

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Data EntryData ReportingQuality AssuranceDatabase ManagementError CorrectionData AnalysisProvider Documentation ManagementMultitaskingWorkload PrioritizationIndependent Work

Soft Skills

Effective Written CommunicationEffective Spoken CommunicationAdaptabilityDeadline ManagementInstruction Acceptance

Industry Keywords

Healthcare FieldProvider DemographicsNetwork ServicesCMS ReportingProvider TypesAffiliationsCredentialing CommitteeCorporate AssignmentsContracted ProvidersDepartmental Standards

About the role

Key responsibilities & impact

Maintain and load provider demographic information received via contracts, roster updates, and/or applications to the CVO
Review data and correct detected errors
Keep information current and remain within departmental standards
Extract and report data for analyses
Help maintain database integrity and quality assurance
Contact providers to obtain missing or incorrect documentation and follow up as necessary
Participate in calls with network services staff to troubleshoot and recommend program enhancements
Assist with the Credentialing Committee approval and denial notification process, including welcome and denial letters
Complete corporate assignments and other duties as assigned
Work with multiple departments and the CVO to ensure contracted providers meet qualifications
Support reporting functions of provider data to agencies, committees, and management

Requirements

What you’ll need

High school diploma or equivalent required
Post-secondary education preferred
Previous experience in the healthcare field required
Prior credentialing experience
Prior experience with CVO platforms strongly preferred
Prior experience in network services data management preferred
Prior experience with Medicare Advantage plans preferred
CMS reporting provider and data reporting experience preferred
Fluent in all provider types, affiliations and relationships
Proficient computer skills
Ability to accurately enter data into information systems
Ability to prioritize workload and adjust to a changing environment
Effective written and spoken communication skills
Ability to handle multiple priorities, multitask, and meet deadlines
Ability to work independently and accept instructions
Travel may be required to come into the corporate office if located within 40 miles

Benefits

Comp & perks

Affordable Medical/Dental/Vision insurance options
Generous paid time-off program and paid holidays for full time staff
TeleDoc 24/7/365 access to doctors
Optional short- and long-term disability plans
Employee Assistance Plan (EAP)
401K retirement accounts with company match
Employee Referral Bonus Program
Remote work from home in a dedicated office space
Flexible hours may be available