Credentialing and Licensing Specialist
J
JobgetherHealthcare Administration
Based in United StatesFull-TimeSenior
Salary22.99 - 34.49 USD per hour
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Job Details
- Experience
- 3–5 years
- Required Skills
- Data management
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, and state licensing requirements is preferred.
- Experience with credentialing platforms, provider databases, payer portals, or HRIS systems is advantageous.
- Strong ability to research and resolve non-routine issues while interpreting established procedures.
- 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.
- Ability to work independently while collaborating effectively across teams.
- CPMSM, CPCS, or equivalent credentialing certification is preferred.
Responsibilities
- 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, and exclusions.
- Research and resolve non-routine credentialing, licensing, and payer enrollment discrepancies.
- Monitor expiration dates and application progress to ensure timely provider participation and continued compliance.
- Maintain accurate provider records and credentialing databases while safeguarding data integrity.
- Communicate directly with healthcare providers, licensing boards, payers, and internal stakeholders to resolve issues.
- Support audits, accreditation reviews, and compliance reporting by gathering documentation and validating records.
- Identify documentation or process gaps and contribute to process improvements.
- Provide informal training, guidance, and quality-review support to less experienced team members.
- Manage multiple priorities and deadlines with attention to detail.
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