Provider Credentialing Specialist II

Qualifacts

. Keep abreast of regulatory developments in the Behavioral Health, Primary Care, and Medical Staff Services industries .

Posted 10/14/2026full-timeUnited StatesMid-LevelSeniorWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in provider credentialing and insurance paneling, ensuring compliance with regulatory standards and maintaining accurate practitioner databases. Strong communication and organizational skills facilitate effective collaboration with leadership and stakeholders.

Highest-signal resume keywords

Provider CredentialingInsurance PanelingRegulatory ComplianceProvider Credentialing Specialist CertificationProject Management

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Credentialing ProcessesVerification AnalysisRecord MaintenanceInsurance Contract ManagementRegulatory Knowledge

Soft Skills

Excellent CommunicationOrganizational SkillsRelationship BuildingTeam-Player OrientationAdaptability

Certifications & Qualifications

Provider Credentialing Specialist Certification

Industry Keywords

Behavioral HealthPrimary CareMedical Staff ServicesJoint CommissionCARFMedicareMedicaidCommercial Payers

About the role

Key responsibilities & impact

Keep abreast of regulatory developments in the Behavioral Health, Primary Care, and Medical Staff Services industries
Maintain compliance with regulatory and accrediting bodies
Collaborate with leadership to develop and implement credentialing processes and procedures
Credential physicians, allied health professionals, and other practitioners
Handle insurance paneling for facilities, physicians, allied health professionals, and other practitioners
Collect and maintain accurate practitioner databases and analyze verification information
Collect and maintain records of licenses, credentials, and insurance contracts
Monitor partners’ and customers’ provider credentials and licenses
Advise partners and customers on renewal procedures
Ensure timely completion of credentialing processes with partners and customers
Release information to agencies and the public as required by law
Escalate credentialing risks to the Billing Manager and partner/customer leadership
Develop and maintain credentialing processes and departmental standards
Monitor credentialing requirements for Joint Commission and CARF
Monitor insurance paneling requirements for Medicare, Medicaid, and commercial payers
Assist with development and operation of a customer call center
Provide credentialing consultations and training as requested

Requirements

What you’ll need

Proven experience in provider credentialing and insurance paneling
In-depth knowledge of industry standards and regulations
Provider Credentialing Specialist certification through NAMSS preferred
Knowledge of credentialing requirements of Partners
Excellent communication and organizational skills
Ability to manage concurrent projects, constituents, and priorities with tight deadlines in a dynamic environment
Ability to build positive and effective relationships with leaders internally and externally
Team-player orientation and alignment with company values and culture
Ability to adhere to company mission and goals
Ability to represent the company, mission, and values to internal and external stakeholders

Benefits

Comp & perks

Equal opportunity employer
Inclusive work environment committed to diversity
Hybrid work schedule in either the Nashville or Tampa office location