Credentialing Specialist

Riverside Health

. Function as the primary liaison for all aspects of the provider onboarding process at Riverside Medical Group .

Posted 11/10/2026full-timeRemote • Virginia • United StatesJuniorMid-Level💰 $21 - $28 per hourWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in provider onboarding and credentialing processes, ensuring compliance with regulatory guidelines and timely resolution of credentialing issues. Proficient in managing provider information across various systems while implementing best practices for quality control.

Highest-signal resume keywords

Provider CredentialingICare/EPIC ExperienceCertified Provider Credentialing Specialist (CPCS)Quality Control FunctionsRegulatory Compliance

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Credential VerificationApplication ReviewQuality Data MonitoringProvider OnboardingClaims Release ManagementCredentialing Process ImprovementLicensure ResearchMalpractice Reporting

Soft Skills

CommunicationProblem-SolvingAttention to Detail

Tools & Technologies

CAQHEchoNPIEMR/EHRPatient Accounting Systems

Certifications & Qualifications

Certified Provider Credentialing Specialist (CPCS)

Industry Keywords

Healthcare CredentialingPrivilegingCMS GuidelinesVA Medical LicenseFederal DEABoard CertificationCLIAPayor Participation

About the role

Key responsibilities & impact

Function as the primary liaison for all aspects of the provider onboarding process at Riverside Medical Group
Verify credential documents, including VA Medical License, Federal DEA, Board Certification, and Visas
Credential and recredential healthcare providers with contracted payors
Review applications and monitor quality data and quality-control functions
Complete and maintain provider applications for initial credentialing and re-credentialing/renewals, including necessary follow-up
Ensure timely provider onboarding to mitigate patient access issues
Release pending claims for newly credentialed providers in a timely manner
Build, update, and maintain provider information in credentialing, CAQH, Echo, NPI, EMR/HER, and patient accounting systems
Maintain provider information in internal and external directories according to CMS and regulatory guidelines
Investigate credentialing issues involving payor participation, physician agreements, billing, place of service, CLIA, and NPI denials
Respond to credentialing issues within 2 business days
Research legal sanctions regarding licensure and report issues before malpractice submission or upon discovery
Recommend best practices and process improvements in credentialing

Requirements

What you’ll need

High School Diploma or GED (Required)
2 years active experience in credentialing/privileging (Required)
Experience in iCare/EPIC (Required)
Certified Provider Credentialing Specialist (CPCS) (Preferred)