Credentialing Specialist

About the position

As a Credentialing Specialist, you are responsible for managing and maintaining the credentialing and re-credentialing processes for all providers in our outpatient pediatric and behavioral health offices. This role ensures all healthcare professionals are properly credentialed, enrolled with insurance plans, and compliant with regulatory and payer requirements. Our mission is to provide high quality, compassionate health care to the families in our communities, treating each child as our own.

Responsibilities

• Prepare, submit, and track initial and re-credentialing applications for physicians, nurse practitioners, and other healthcare providers.
• Maintain current and accurate provider information in internal systems and with insurance carriers.
• Monitor license expirations, board certifications, DEA registrations, malpractice insurance, and other credentialing-related documentation.
• Ensure compliance with all payer and regulatory credentialing requirements, including NCQA, CAQH, Medicaid, and Medicare.
• Communicate with insurance companies, licensing boards, and providers to resolve issues or obtain required documentation.
• Maintain provider files and credentialing software/database with up-to-date, organized records.
• Respond to credentialing-related inquiries from internal staff, insurance companies, and external partners.
• Assist with payer enrollments, terminations, and updates for insurance panels.
• Track and manage credentialing deadlines to avoid lapses in network participation.
• Support audits and compliance reviews related to provider credentials.
• Coordinate with HR and billing departments to ensure credentialing impacts are addressed proactively.
• Complete all mandatory training as required.
• Perform other duties as assigned.

Requirements

• High school diploma or equivalent required; associate or bachelor's degree preferred.
• Minimum 1–2 years of credentialing experience, preferably in a pediatric or outpatient healthcare setting.
• Knowledge of credentialing processes, insurance payers, and regulatory standards (e.g., CAQH, Medicare, Medicaid).
• Strong organizational skills with high attention to detail.
• Excellent written and verbal communication skills.
• Proficiency with credentialing software, Microsoft Office (Word, Excel, Outlook), and practice management systems.
• Ability to work independently and manage multiple deadlines simultaneously.

Benefits

• Paid Time Off
• Matching 401K
• Annual Merit Increases
• Mental Health and Counseling Programs
• Dental and Orthodontic Coverage
• Vision Insurance
• Health Care with Low Premiums
• Short-term Disability
• Access to Virtual Health & Wellness