Credentialing Specialist

• Manage initial credentialing, recredentialing, and provider enrollment processes
• Prepare, submit, and monitor credentialing applications to hospitals, health plans, government payers, and other credentialing entities
• Maintain accurate and current provider information in credentialing databases
• Track credential expirations, including licenses, certifications, DEA registrations, malpractice insurance, and other required documentation
• Obtain renewal documentation proactively to prevent credentialing lapses
• Monitor application status and follow up with payers and credentialing organizations
• Maintain compliance with federal, state, payer, and organizational credentialing requirements
• Conduct primary source verification according to accreditation and regulatory standards
• Review provider files for completeness and accuracy before submission
• Assist with provider enrollment, revalidation, and demographic updates with Medicare, Medicaid, and commercial insurance carriers
• Respond to credentialing inquiries from providers, leadership, clients, and payer representatives
• Prepare credentialing reports and provide status updates to leadership
• Support audits and accreditation reviews by maintaining organized and compliant provider files
• Collaborate with internal departments to resolve credentialing and enrollment issues affecting provider participation or reimbursement
• Maintain confidentiality of sensitive provider and organizational information
• Meet credentialing and enrollment timelines, maintain provider participation without lapses, ensure record accuracy, comply with requirements, and achieve service-level agreements and performance metrics