Healthcare Credentialing Specialist

FP&C

. Manage an individual caseload of initial credentialing and recredentialing files from application intake through submission for review .

Posted 11/3/2026full-timeRemote • United StatesMid-LevelSenior💰 $65,000 - $80,000 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates extensive experience in healthcare provider credentialing, including initial credentialing, recredentialing, and primary source verification. Proficient in managing credentialing workflows, ensuring compliance, and implementing process improvements while maintaining meticulous attention to detail.

Highest-signal resume keywords

Healthcare Provider Credentialing ExperiencePrimary Source VerificationCredentialing OversightKnowledge of CAQH, NCQA, URACCredentialing Database Proficiency

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Credentialing ProcessesDocumentation RequirementsQuality AssuranceAuditingProcess ImprovementsBackground ChecksExclusion ChecksData AnalysisCompliance MonitoringWorkflow Coordination

Soft Skills

Attention to DetailAnalytical SkillsOrganizational SkillsProblem-Solving SkillsClear Communication

Tools & Technologies

Credentialing DatabasesMicrosoft Office ApplicationsElectronic Records

Industry Keywords

CredentialingRecredentialingProvider QualificationsHealthcare ProgramsTRICARE Credentialing

About the role

Key responsibilities & impact

Manage an individual caseload of initial credentialing and recredentialing files from application intake through submission for review
Provide day-to-day oversight of credentialing workflows and processes
Coordinate priorities and help address backlogs and processing delays
Review and audit credentialing packets for accuracy, completeness, consistency, and compliance
Perform and document primary source verification of provider qualifications, including licensure, education, training, and certifications
Identify documentation gaps and discrepancies, obtain missing information, and maintain follow-up records
Complete required background and exclusion checks, document findings, and escalate adverse information or exceptions
Monitor credentialing progress, turnaround times, and quality standards
Communicate workload concerns and deadline risks
Maintain accurate credentialing databases and organized, audit-ready files
Monitor expiring credentials and recredentialing deadlines, initiating follow-up early
Provide guidance and support to credentialing staff and stakeholders
Assist with staff onboarding and training
Identify recurring errors and process weaknesses; recommend and implement approved improvements
Prepare status reports, support audits, and protect confidential provider and organizational information

Requirements

What you’ll need

Minimum of five years of healthcare provider credentialing experience, including initial credentialing, recredentialing, and primary source verification
Experience providing credentialing oversight, auditing, or quality assurance while maintaining hands-on responsibility for credentialing work
Experience coordinating credentialing processes or implementing process improvements
Experience reviewing work prepared by others, resolving complex documentation issues, and meeting established turnaround times
Knowledge of CAQH, NCQA, URAC, and government healthcare programs is preferred
TRICARE credentialing experience is a plus, but is not required
Meticulous attention to detail
Strong knowledge of provider credentialing processes, documentation requirements, and verification methods
Ability to interpret and apply applicable credentialing requirements and client and program procedures
Strong analytical, organizational, and problem-solving skills
Ability to balance an individual caseload with workflow oversight, quality reviews, and timely follow-through on team priorities
Ability to remain composed, exercise sound judgment, and communicate professionally when managing urgent requests, competing deadlines, and changing priorities
Clear written and verbal communication skills, including the ability to explain requirements, provide constructive feedback, and guide colleagues and stakeholders
Ability to resolve issues within delegated authority and escalate matters requiring management review or credentialing decisions
Proficiency with credentialing databases, Microsoft Office applications, and electronic records
Discretion and sound judgment when handling sensitive and confidential information
Consistent, full-time availability Monday through Friday, eight hours per day
Reliable internet access and a home office setup conducive to focused computer-based work

Benefits

Comp & perks

Health, Dental and Vision Insurance
Group Life Insurance
Short Term Disability Insurance
Long-Term Disability Insurance
401K with company match
Paid Time Off and Holidays
Supplemental Benefits
Remote/home office work environment