Credentialing and Privileging Specialist

Highmark Health

Credentialing specialist managing practitioner credentials and privileges for Allegheny Health Network. Verifying qualifications, maintaining files, and supporting regulatory compliance.

Posted 9/3/2026full-timeRemote • Alabama, Alaska, Arizona, California, Colorado, Connecticut, District of Columbia, Florida, Hawaii, Idaho, Illinois, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Minnesota, Mississippi, Missouri, Montana, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Vermont, Virginia, Washington, West Virginia, Wisconsin, Wyoming • 🇺🇸 United StatesMid-LevelSenior💰 $22 - $34 per hourWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in credentialing and privileging processes, ensuring compliance with regulatory standards and maintaining accurate practitioner records. Proficient in managing verification activities and addressing customer inquiries within a healthcare environment.

Highest-signal resume keywords

Credentialing And PrivilegingVerification ActivitiesRegulatory ComplianceCustomer ServiceCPCS Or CPMSM Certification

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Office AdministrationData VerificationDocument ManagementBackground InvestigationFocused Professional Practice EvaluationsCredentialing Software MaintenanceApplication ReviewDiscrepancy EvaluationAdverse Information DocumentationHealth Insurance Knowledge

Soft Skills

CommunicationProblem-SolvingAttention To DetailCustomer Interaction

Certifications & Qualifications

Certified Provider Credentialing Specialist (CPCS)Certified Professional Medical Services Management (CPMSM)

Industry Keywords

Department Of HealthJoint CommissionNCQAURACHIPAA ComplianceHealthcare EnvironmentManaged Care

About the role

Key responsibilities & impact

Coordinate and implement credentialing and privileging activities within the Credentialing and Privileging Office
Manage appointment, reappointment, and ongoing verification activities for Medical Staff and Allied Health Professional Staff
Investigate and document practitioner credentials, including background, training, and past practice
Review appointment and reappointment applications for accurate and appropriate data
Determine primary sources for verifications and document verification in practitioner files
Perform follow-up and second-source verification when necessary
Verify practitioners meet criteria for requested privileges and perform focused professional practice evaluations, reappointments, status or privilege changes, and temporary privileges
Evaluate verifications for discrepancies and investigate questionable information
Notify supervisors and management of adverse or questionable verification responses
Create scanned references of adverse or potentially adverse information for facility downloads when appropriate
Document verification and inquiry results according to regulatory standards and entity agreements
Maintain credentialing and privileging software for tracking queries, verification methods, privilege information, and related activities
Maintain Medical Staff and Allied Health Professional Staff credential files
Assist with monthly Credentials Committee and Allied Health Professional Subcommittee agendas
Handle customer questions and complaints
Perform other duties as assigned or required

Requirements

What you’ll need

High School / GED
3 years of general office administration work in a business, education, or healthcare environment
Knowledge of credentialing and privileging requirements of the Department of Health, Joint Commission, NCQA, URAC and other governmental requirements
Preferred: Associate's Degree
Preferred: 3 years with physician credentialing and privileging, medical education, hospital environment, health insurance or managed care
Preferred: 1 year in customer service
Preferred: Certified Provider Credentialing Specialist (CPCS) or Certified Professional Medical Services Management (CPMSM)
Compliance with HIPAA, data security guidelines, company policies, applicable laws, rules, regulations, and training requirements

Benefits

Comp & perks

Remote work
Base pay range of $21.97–$34.39 per hour
HIPAA and privacy/security policy training and compliance support
Accessibility and application accommodation support