Credentialing Specialist

Independent Health

. Maintain timely and accurate credentialing and re-credentialing of all Independent Health providers .

Posted 9/28/2026full-timeBuffalo • New York • United StatesJuniorMid-Level💰 $20 - $23 per hourWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in credentialing processes, ensuring compliance with NCQA, DOH, and CMS regulations while maintaining accurate provider documentation. Strong organizational and time management skills are essential for managing multiple projects and meeting strict deadlines.

Highest-signal resume keywords

Credentialing ExperienceHealthcare Operations ExperienceHealthRules System ProficiencyMicrosoft Word ProficiencyExcellent Customer Service Skills

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

CredentialingProvider Data ManagementPrimary Source VerificationDatabase ManagementRegulatory ComplianceApplication ProcessingDocument ReviewData AccuracyTime ManagementProject Management

Soft Skills

Excellent Communication SkillsOrganizational SkillsDecision-Making SkillsAbility to Work IndependentlyCustomer Service Orientation

Tools & Technologies

HealthRulesVisual CactusCredentialing SoftwareCredentialing Database

Industry Keywords

NCQADOHCMSHealthcareProvider Credentialing

About the role

Key responsibilities & impact

Maintain timely and accurate credentialing and re-credentialing of all Independent Health providers
Manage provider files and documentation in adherence with regulatory requirements and Independent Health policies
Work with internal departments to ensure provider data accuracy
Provide effective, professional external customer service
Maintain all work through the Healthrules system
Input provider applications into the credentialing database and process within required time frames
Ensure applications are complete, accurate, and compliant with NCQA, DOH, CMS, and Independent Health policy requirements
Complete and close clean, routine applications and assigned recredential files within required time frames
Initiate credentialing packets as assigned and scheduled
Track processes to maintain compliance with federal, state, NCQA, and internal requirements
Follow up and take action on conflicting or incomplete information
Review and edit files for completeness and accuracy before analyst review
Maintain Network Evaluation process and physician network profiles
Gather and document information from respective departments for recredentialing review
Perform primary source verification using credentialing software according to IPA/WNY policies and procedures
Query primary sources by letter or phone to verify information
Initiate additional requests when responses are not received within required time frames
Query databases and internet sources to verify licenses, board information, sanctions, and claims history
Maintain the credentialing database and provider hard-copy files
Enter changes and update provider credentialing database records in Cactus and Health Rules
Remain current and informed on credentialing policies and procedures
Generate routine and follow-up reports from the system
Provide the manager with month-end status reports of assigned files

Requirements

What you’ll need

High School diploma or GED required
Associates Degree preferred
Two (2) years of healthcare operations experience required
Credentialing experience preferred
Demonstrated experience in Windows and Microsoft Word
Knowledge of HealthRules and Visual Cactus preferred
Excellent organizational and time management skills with ability to prioritize work according to established deadlines
Must be able to manage multiple projects
Ability to work independently owning a process from start to finish while under strict deadlines
Decision-making skills commensurate with position responsibilities
Excellent written and verbal communication skills
Demonstrated ability to communicate with physicians and health care providers
Excellent customer service skills
Proven examples of displaying the IH values: Passionate, Caring, Respectful, Trustworthy, Collaborative and Accountable
Immigration or work visa sponsorship will not be provided for this position

Benefits

Comp & perks

Scorecard incentive eligibility
Full range of benefits
Generous paid time off