Credentialing Specialist

About the Credentialing Specialist Job

If you’re detail-oriented and passionate about healthcare data accuracy, this Credentialing Specialist job in the health insurance industry offers an exciting opportunity to grow your career. You’ll play a vital role in verifying provider credentials, maintaining compliance, and supporting provider participation within the network. As a Credentialing Specialist, you’ll ensure that all documentation and eligibility requirements are met while helping enhance the overall provider experience.

This role provides competitive pay of up to $70,620, a supportive work environment, and the chance to make a meaningful impact in healthcare operations.

Key Responsibilities of a Credentialing Specialist

In this Credentialing Specialist position, your primary responsibilities will include:

• Reviewing and analyzing provider credentialing applications for network participation.

• Performing primary source verification of credentials in compliance with company and regulatory standards.

• Responding to inquiries about provider eligibility, credentialing, and contract status.

• Maintaining and updating provider files, both in hard copy and electronic systems.

• Identifying and resolving discrepancies or issues related to provider data.

• Preparing written responses and communicating effectively to obtain missing documentation.

Qualifications for the Credentialing Specialist Job

To qualify for this Credentialing Specialist role, candidates must have:

• A minimum of a High School Diploma or GED.

• At least 3 years of experience in physician credentialing or related healthcare/managed care operations.

• Strong proficiency with Excel, including Pivot Tables.

• Excellent communication and interpersonal skills.

• Understanding of medical terminology and ability to follow standard operating procedures.

Preferred Qualifications:

• Bachelor’s Degree in Business, Healthcare Administration, or a related discipline.

• Certified Provider Credentialing Specialist (CPCS) certification.

Why You’ll Love This Credentialing Specialist Opportunity

This Credentialing Specialist job offers more than just a paycheck — it’s a chance to grow in a supportive, career-driven environment. You’ll enjoy:

• A competitive salary up to $70,620.

• Comprehensive benefits, including incentive programs and 401(k) contributions.

• Opportunities for career advancement and internal growth.

• A collaborative workplace culture that values your contribution.

• The ability to positively impact provider relationships and healthcare data integrity.