Credentialing Specialist

Position Summary

The Credentialing Coordinator will be responsible for performing tasks related to the credentialing of new providers, including document collection, verification, and file maintenance. The role ensures that all credentialing documentation is confidential and securely maintained, while assisting providers and facilities in understanding and adhering to credentialing policies and procedures.

Key Responsibilities

1. Maintain communication with credentialing contacts at facilities and provider sites for credentialing, re-credentialing, and provider updates.
2. Review provider credentialing files for completion and prepare for Credentialing Committee presentation.
3. Perform primary source verification in accordance with established policies and procedures.
4. Enter and update provider information in the credentialing database.
5. Verify sanctions, restrictions, or limitations on licensure/practice with appropriate state and federal databases.
6. Generate and distribute monthly provider credentialing updates to internal departments and participating providers/facilities.
7. Create, copy, file, and maintain all relevant credentialing documentation.
8. Conduct annual delegated file audits and participate in pre-delegation/delegation reviews.
9. Respond to inquiries from internal departments regarding provider credentialing status.
10. Perform other related tasks as assigned by leadership.

Skills & Qualifications

• Excellent communication and organizational skills.
• Experience with provider credentialing processes and procedures.
• Strong computer skills; proficient in MS Office.
• Knowledge of credentialing systems (e.g., CACTUS) preferred.
• Familiarity with healthcare credentialing policies and compliance standards preferred.

Education

• High School diploma or equivalent required.
• Bachelor’s degree preferred.

Schedule

• Start Date: 09/22/2025
• End Date: 11/22/2025
• Hours per Week: 35
• Hours per Day: 7
• Days per Week: 5
• Work Schedule: 9 AM – 5 PM, Hybrid (2 days on-site; Thursday mandatory)

Pride Health offers eligible employees comprehensive healthcare coverage (medical, dental, and vision plans), supplemental coverage (accident insurance, critical illness insurance, and hospital indemnity), 401(k)-retirement savings, life & disability insurance, an employee assistance program, legal support, auto, home insurance, pet insurance, and employee discounts with preferred vendors.