Credentialing Specialist

The Credentialing Specialist is responsible for managing and coordinating the credentialing and re-credentialing processes for healthcare providers, professionals, or organizational partners. This role ensures compliance with regulatory standards, accreditation requirements, and internal policies. The Credentialing Specialist maintains accurate records, verifies documentation, and works closely with providers and internal departments to ensure timely approval and ongoing compliance. This position operates in a fully remote environment.

This position is strictly limited to candidates who currently reside in the United States and are legally authorized to work in the U.S. Applications from individuals residing outside the United States will be rejected.

Key Responsibilities

• Manage end-to-end credentialing and re-credentialing processes for providers or staff

• Verify licensure, certifications, education, training, and work history

• Ensure compliance with federal, state, and accreditation standards

• Maintain accurate and up-to-date credentialing files and databases

• Submit credentialing applications to payers, regulatory bodies, or accreditation organizations

• Track renewal deadlines and ensure timely re-credentialing

• Communicate with providers to obtain required documentation and resolve discrepancies

• Prepare credentialing reports and audit documentation

• Support internal and external audits related to credentialing compliance

• Collaborate with HR, compliance, and operations teams to ensure proper onboarding

Required Qualifications

• Associates or Bachelors degree in Healthcare Administration, Business Administration, or related field (or equivalent experience)

• 2–5 years of experience in credentialing, healthcare administration, or compliance roles

• Knowledge of credentialing standards and regulatory requirements

• Strong attention to detail and organizational skills

• Experience with credentialing software or databases

• Excellent written and verbal communication skills

• Ability to manage multiple deadlines in a remote environment

Preferred Qualifications

• Certified Provider Credentialing Specialist (CPCS) or Certified Professional Medical Services Management (CPMSM) credential

• Experience working with payer enrollment and provider contracting

• Familiarity with healthcare regulations and accreditation standards (e.g., NCQA, Joint Commission)

• Experience in hospital, healthcare network, or telehealth environments

• Knowledge of medical terminology

Compensation

• Annual Salary Range: $55,000 – $75,000 USD, based on experience, certifications

Benefits

• Comprehensive medical, dental, and vision insurance

• 401(k) retirement plan with employer matching

• Paid time off, paid holidays, and sick leave

• Life, short-term, and long-term disability insurance

• Flexible remote work arrangement

• Professional development and certification reimbursement

• Employee wellness and assistance programs

Work Authorization & Residency Requirement

• Must be legally authorized to work in the United States

• Must currently reside within the United States

• Applications from candidates outside the U.S. will not be considered