Credentialing Specialist

Description:

As a Credentialing Specialist, you will be responsible for coordinating and completing credentialing and re-credentialing applications, managing physician document compliance, and ensuring all applications are processed accurately and on time. This position requires excellent organizational skills, proactive follow-up, and prior experience with U.S. hospital privileging and payer enrollment.

Key Responsibilities

i. Manage multiple physician credentialing files simultaneously (new applications, renewals, re-credentialing).

ii. Collect, verify, and maintain all required physician documents (licenses, CVs, logs, certifications, references, etc.).

iii. Prepare, submit, and track hospital and payer credentialing applications.

iv. Ensure compliance with NCQA, CAQH, and hospital credentialing standards.

v. Proactively follow up with physicians, hospitals, and payers to avoid delays.

vi. Maintain accurate credentialing databases, trackers, and reporting.

vii. Support CV formatting and compliance edits as per U.S. credentialing requirements.

viii. Provide regular status updates to management and client teams.

Qualifications & Skills

a. Minimum 3 years of experience in U.S. healthcare credentialing (hospital privileges & payer enrollment).

b. Familiarity with locum tenens, multi-specialty groups, or hospital credentialing preferred.

c. Strong understanding of NCQA, CAQH, and credentialing best practices.

d. Proven ability to handle high-volume credentialing workflows.

e. Excellent English communication skills, both written and verbal.

f. Ability to manage physician documentation and follow-up professionally.

g. Strong organizational and database management skills (Excel, credentialing software, cloud systems).

h. Ability to work U.S. business hours (Eastern / Central time zones).

i. Self-motivated, detail-oriented, and capable of aggressive follow-up when needed.