Credentialing Specialist

Point32Health

. Maintain and process physician and provider credentialing information for new and established health plan practitioners .

Posted 10/15/2026full-timeRemote • Massachusetts • United StatesJunior💰 $24 - $36 per hourWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in maintaining and processing physician and provider credentialing information, with a strong focus on accuracy and compliance. Proficient in utilizing credentialing information systems and managing time-sensitive tasks effectively.

Highest-signal resume keywords

Credentialing Information System ManagementProvider Contract Information AssessmentLicense and Board Certification VerificationStrong Written and Verbal CommunicationOrganizational Skills and Attention to Detail

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Credentialing Information SystemProvider Contract AssessmentLicense VerificationBoard Certification VerificationData EntryFile PreparationEmergency Situation IdentificationTime-Sensitive Information ProcessingTask PrioritizationHealthcare Experience

Soft Skills

Strong Written SkillsStrong Verbal SkillsJudgementInitiativeAdaptability

Tools & Technologies

Cactus Credentialing Information SystemPersonal ComputerTelephone/Headset

Industry Keywords

Healthcare CredentialingNational Practitioner Data BankCredentialing ComplianceCertified Verification OrganizationQuality-of-Care Committee

About the role

Key responsibilities & impact

Maintain and process physician and provider credentialing information for new and established health plan practitioners
Assess adequate and accurate participation information, including provider contract information
Enter initial and existing credentialing applications into the Cactus credentialing information system
Verify licenses, board certification, and other required credentials through various sources
Review and report adverse information from the National Practitioner Data Bank and state/federal sanctions
Retrieve missing or expired information and documentation required for credentialing
Serve as a resource for physician and provider questions about certification and credentialing
Identify complex or sensitive issues for the Credentialing Supervisor and potential review by a Medical Director or outside source
Prepare files meeting credentialing criteria for Credentialing Compliance Coordinator/Supervisor review and Medical Director file review
Prepare files not meeting criteria for Medical Director, Senior Credentialing Specialist, or Supervisor review and Quality-of-Care Committee presentation
Process practitioners under entity agreement terms, including files credentialed through a Certified Verification Organization
Participate in assigned task forces and meetings
Perform other assigned duties and projects

Requirements

What you’ll need

High school diploma required
1-2 years of experience in healthcare field
Experience with personal computer
Ability to appropriately identify emergency situations and follow the appropriate protocol
Ability to maintain and manipulate a complex credentialing information system
Ability to prioritize multiple tasks and achieve deadlines
Ability to adapt to changing environment
Strong written and verbal skills
Initiative, judgement, exceptional organizational skills and keen attention to detail
Ability to work and process time-sensitive information
Ability to work under normal office conditions and from home as required
Ability to use a telephone/headset and PC/keyboard simultaneously and sit for extended durations
May be required to work additional hours beyond standard work schedule

Benefits

Comp & perks

Medical, dental and vision coverage
Retirement plans
Paid time off
Employer-paid life and disability insurance with additional buy-up coverage options
Tuition program
Well-being benefits
Full suite of benefits to support career development, individual & family health, and financial health
Variable pay eligibility