Credentialing and Licensing Specialist

Accountabilities:

• • Manage provider credentialing, recredentialing, licensing, payer enrollment, and renewal activities from application through completion.
  • Review, validate, and maintain documentation including professional licenses, certifications, education, training, malpractice coverage, work history, sanctions, exclusions, and other required provider information.
  • Research and resolve non-routine credentialing, licensing, payer enrollment, and provider data discrepancies, escalating complex regulatory or compliance matters when appropriate.
  • Monitor expiration dates, application progress, outstanding documentation, and renewal deadlines to ensure timely provider participation and continued compliance.
  • Maintain accurate and complete provider records and credentialing databases while safeguarding data integrity.
  • Communicate directly with healthcare providers, licensing boards, payers, credentialing committees, regulatory agencies, and internal stakeholders to clarify requirements, provide status updates, and resolve issues.
  • Support audits, accreditation reviews, compliance reporting, and credentialing committee activities by gathering documentation, validating records, and responding to information requests.
  • Identify documentation or process gaps and contribute to improvements that increase credentialing accuracy, efficiency, and timeliness.
  • Provide informal training, guidance, and quality-review support to less experienced credentialing team members on systems, procedures, and documentation standards.
  • Manage multiple priorities and deadlines while maintaining a high level of attention to detail and follow-through.

  Requirements:

  • High school diploma or equivalent required; an associate degree is preferred.
  • 3–5 years of experience in healthcare credentialing, provider licensing, provider enrollment, healthcare administration, or a related field.
  • In-depth knowledge of provider credentialing, recredentialing, licensing, payer enrollment, and provider data management processes.
  • Working knowledge of applicable regulatory, accreditation, payer, and organizational credentialing requirements.
  • Familiarity with NCQA, CMS, state licensing requirements, or comparable healthcare standards is preferred.
  • Experience with credentialing platforms, provider databases, payer portals, HRIS systems, or other provider data management technologies is advantageous.
  • Strong ability to research and resolve non-routine issues while interpreting established procedures and requirements.
  • Exceptional attention to detail, organization, follow-through, and documentation accuracy.
  • Ability to manage multiple deadlines and competing priorities in a structured, compliance-focused environment.
  • Strong written and verbal communication skills, with the ability to interact professionally with providers, payers, agencies, and internal stakeholders.
  • Ability to work independently while collaborating effectively across teams.
  • CPMSM, CPCS, or equivalent credentialing certification is preferred but not required.

  Benefits:

  • Anticipated base compensation range of $22.99–$34.49 per hour.
  • Actual compensation may vary based on experience, skills, qualifications, geographic location, internal equity, and business needs.
  • Remote work opportunity within the United States.
  • Full-time employment in a healthcare-focused environment.
  • Opportunity to work across provider credentialing, licensing, enrollment, regulatory compliance, and healthcare operations.
  • Exposure to audits, accreditation activities, payer requirements, and cross-functional healthcare stakeholders.
  • Opportunities to provide guidance and quality support to other credentialing professionals.
  • Equal employment opportunity and reasonable accommodation support for qualified applicants.