Senior Credentialing Specialist
Core
Ensures network providers comply with company, state, and regulatory body requirements by reviewing, validating, and analyzing provider information.
Role type
Senior Credentialing Specialist
Builds
Provider data integrity and network compliance
Domain
Healthcare administration / Regulatory compliance
Deliverable
dashboards & analysis
Required skills
Provider verification, State licensure management, Regulatory compliance (NCQA, URAC, Medicare, Medicaid), Data integrity, Process improvement, Training material development
Preferred skills
NAMSS CPCS certification, Google Suite proficiency
Responsibilities
Conduct ongoing verification of state licenses, exclusion lists, DEAs, and board certifications; Manage clinician enrollment, state licensure applications, and renewals; Prepare and conduct training on Network Activation policies; Drive process improvement initiatives; Act as primary liaison for clinicians and internal departments.
Seniority
Mid-level, hands-on specialist