Healthcare Credentialing Specialist

Description

The Healthcare Credentialing Specialist performs healthcare provider credentialing and recredentialing while providing oversight of credentialing workflows, file quality, and timely processing. This role combines hands-on credentialing responsibilities with packet reviews, auditing, quality assurance, and guidance to staff and stakeholders to ensure accurate, complete, and timely provider credentialing.

This position requires a meticulous professional who can manage an individual caseload while monitoring the quality and progress of credentialing activities across the team. The successful candidate brings sound judgment, consistent follow-through, and a disciplined approach to managing competing deadlines and changing priorities.

Key Responsibilities

• •Manage an individual caseload of initial credentialing and recredentialing files from application intake through submission for review.
• •Provide day-to-day oversight of credentialing workflows and processes, coordinating priorities and helping address backlogs and processing delays.
• •Review and audit credentialing packets, including work prepared by others, for accuracy, completeness, consistency, and compliance with applicable credentialing, client, and program requirements.
• •Perform and document primary source verification of provider qualifications, including licensure, education, training, and certifications, as required.
• •Identify documentation gaps and discrepancies, obtain missing information, and maintain clear follow-up records to resolve outstanding items promptly.
• •Complete required background and exclusion checks, document findings, and escalate adverse information or exceptions for appropriate review.
• •Monitor credentialing progress, turnaround times, and quality standards; communicate workload concerns and deadline risks.
• •Maintain accurate credentialing databases and organized, audit-ready files, including verification dates, expiration dates, correspondence, and status updates.
• •Monitor expiring credentials and recredentialing deadlines, initiating follow-up early to help prevent delays or lapses.
• •Provide guidance and support to credentialing staff and stakeholders, clarify procedures, and assist with staff onboarding and training.
• •Identify recurring errors and process weaknesses; recommend and implement approved improvements to increase efficiency and accuracy.
• •Prepare status reports, support audits, and protect confidential provider and organizational information.

Requirements

Education & Experience

• •Minimum of five years of healthcare provider credentialing experience, including initial credentialing, recredentialing, and primary source verification.
• •Experience providing credentialing oversight, auditing, or quality assurance while maintaining hands-on responsibility for credentialing work.
• •Experience coordinating credentialing processes or implementing process improvements.
• •Experience reviewing work prepared by others, resolving complex documentation issues, and meeting established turnaround times.
• •Knowledge of CAQH, NCQA, URAC, and government healthcare programs is preferred.
• •TRICARE credentialing experience is a plus, but is not required.

Required Knowledge, Skills & Abilities

• •Meticulous attention to detail, with a disciplined approach to reviewing documentation, identifying inconsistencies, and preventing errors.
• •Strong knowledge of provider credentialing processes, documentation requirements, and verification methods.
• •Ability to interpret and apply applicable credentialing requirements and client and program procedures.
• •Strong analytical, organizational, and problem-solving skills.
• •Ability to balance an individual caseload with workflow oversight, quality reviews, and timely follow-through on team priorities.
• •Ability to remain composed, exercise sound judgment, and communicate professionally when managing urgent requests, competing deadlines, and changing priorities.
• •Clear written and verbal communication skills, including the ability to explain requirements, provide constructive feedback, and guide colleagues and stakeholders.
• •Ability to resolve issues within delegated authority and escalate matters requiring management review or credentialing decisions.
• •Proficiency with credentialing databases, Microsoft Office applications, and electronic records.
• •Discretion and sound judgment when handling sensitive and confidential information.

Work Schedule

Consistent, full-time work expected Monday through Friday, eight hours per day in a focused and fast-paced environment.

Americans with Disabilities Specifications

Physical Demands: Work involves regular computer use, including typing, reading from a screen, and participating in virtual meetings. Individuals may choose to sit or stand as preferred in their home office environment.

Work Environment: Remote/home office with reliable internet access and a setup conducive to focused computer-based work.

Pay & Benefits

Salary offered will be commensurate with experience for individuals in similarly situated roles. FP&C offers a competitive benefits package including:

• •Health, Dental and Vision Insurance
• •Group Life, Short Term Disability and Long-Term Disability Insurance
• •401K with company match
• •Paid Time Off and Holidays
• •Supplemental Benefits

EEO Statement

FP&C is an equal opportunity employer, and we are committed to seeking, employing, and treating all employees and applicants for employment without discrimination based on all characteristics protected by federal, state and/or local laws. Applicants can learn more about the company’s status as an equal opportunity employer by viewing the federal EEO poster: https://www.eeoc.gov/poster .