Job Description

Job Description

Job Description

Description:

What it means to be a Credentialing Specialist with Us

We value our families we serve, our communities and our team members. 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

At our offices, we do our best each day to provide high quality, compassionate health care to the families in our communities, treating each child as our own. Our staff and providers strive to make each encounter pleasant and informative while respecting the time and individual needs of our patients and families.

Benefits that Matter!

• 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

What a day looks like as a Credentialing Specialist

• 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.
• Meets position requirements and performs essential functions.
• Completes all mandatory training as required.
• Performs other duties as assigned.

Qualifications

• 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.

Working Conditions & Physical Requirements

• Indoor, temperature controlled, smoke free environment.
• May at times work under stressful situations.
• Handicapped accessible.

Pay is detemined by years of experience as well as location(s) of the office. We hope that you find this position as an exciting opportunity and look forward to the potential of speaking with you!

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