Credentialing Specialist

• Coordinate and manage credentialing and recredentialing processes for new and existing NCPS clinicians across internal and external affiliations
• Communicate with providers, hospitals, Medical Staff Offices, credentialing bodies, and other stakeholders
• Obtain, prepopulate, review, verify, submit, and track credentialing applications and supporting documentation
• Support provider onboarding through intake, document collection, milestone tracking, orientation readiness, and start-date preparedness
• Maintain accurate provider records, credentialing files, licenses, certifications, education, training, and professional references in electronic databases and other systems
• Monitor expiring credentials and privileges, notify providers, and follow up on timely renewals
• Process credentialing fees as applicable
• Resolve credentialing issues and discrepancies with providers and hospitals
• Complete credentialing tasks within timelines and proactively communicate progress and issues
• Provide regular updates to leadership and maintain high-quality, accurate outputs
• Develop and maintain relationships with providers, affiliate organizations, Medical Staff Offices, hospitals, and regulatory bodies
• Provide support, guidance, training, and answers to questions about credentialing and privileging
• Participate in quality improvement activities, analyze data, identify improvements, and implement process improvements
• Ensure NCPS providers are credentialed, recredentialed, and, where applicable, privileged at all locations where services are rendered
• Partner with practice leadership, operations, TM&E, Medical Staff Offices, and affiliate contacts to resolve onboarding and credentialing readiness issues
• Support MSO and telehealth credentialing readiness activities; payer enrollment functions are excluded unless specifically assigned

Credentialing Specialist coordinating provider onboarding for Miami children's healthcare system

Credentialing Specialist – Full Time, Day Shift

Credentialing Specialist coordinating provider onboarding, credentialing, and privileging for Nicklaus Children's Health System. Maintaining compliant provider records and readiness across hospitals, telehealth, and affiliates.

• Managing credentialing, recredentialing, and licensure process for clinical staff with health insurance plans, certification boards and other agencies
• Ensuring compliance with various state, federal and payer requirements
• Responsible for pre-application intake, monitoring, application submission and follow up
• Maintaining an efficient and compliant on-boarding process
• Inputing/Updating provider credential databases CAQH and NPPES
• Ongoing monitoring of clinical staff’s credentials to ensure licenses and certifications are current and active
• Working closely with internal departments to exchange provider information and follow up on inconsistencies
• Assisting with other miscellaneous duties in the Revenue and Contracting department

Credentialing Specialist for Kyo managing ABA therapy staff processes

Credentialing Specialist at Kyo empowering children with autism through ABA therapy. Managing credentialing, compliance, and staff onboarding for clinical teams across multiple states.

• Manage the credentialing and recredentialing process for approximately 132 providers across 12 healthcare facilities.
• Verify provider licensure, certifications, education, work history, malpractice coverage, and other required documentation.
• Prepare and submit credentialing, recredentialing, payer enrollment, and hospital privilege applications.
• Maintain accurate provider records and credentialing databases.
• Monitor expiration dates and coordinate timely renewals to maintain compliance.
• Communicate with providers, payers, and facility administrators to resolve credentialing issues and obtain required documentation.
• Ensure compliance with NCQA, CMS, Joint Commission, payer, and organizational standards.
• Generate reports and maintain organized workflows to support credentialing operations.

Credentialing Specialist managing provider credentialing across multiple healthcare facilities

Medical Credentialing Specialist

Credentialing Specialist managing provider credentialing for healthcare organizations. Responsible for verifying licenses, certifications and maintaining compliance documentation across multiple facilities.

• Own the end-to-end payer enrollment process for new and existing providers, including initial enrollments, revalidations, demographic updates, terminations, and maintenance across commercial, Medicare, and Medicaid health plans.
• Submit, track, and proactively follow up on payer enrollment applications to ensure timely provider participation and minimize delays to patient care and revenue.
• Serve as the primary point of contact with national and local health plans, delegated credentialing organizations, CVOs, and internal stakeholders to resolve enrollment issues, missing information requests, and payer escalations.
• Maintain accurate provider data across payer portals, CAQH, credentialing systems, and internal tracking tools, ensuring consistency across all platforms.
• Support delegated credentialing activities by maintaining provider rosters, submitting required updates, monitoring compliance requirements, and preparing documentation for internal and external audits.
• Conduct routine audits of provider enrollment and credentialing files to ensure compliance with NCQA, CMS, state, and payer-specific requirements.
• Monitor key enrollment and credentialing metrics, identify risks to provider participation, and communicate status updates and timelines to leadership and cross-functional partners.
• Collaborate closely with Licensing, Practice Operations, Revenue Cycle, Recruiting, and Clinical Operations teams to ensure providers are fully credentialed, enrolled, and ready to see patients on schedule.
• Identify opportunities to improve enrollment and credentialing workflows through process standardization, documentation, automation, and operational efficiencies.
• Support provider licensing activities as needed, including coordinating new state license applications, renewals, cross-licensure efforts, and maintaining accurate licensure records.
• Monitor provider licenses, DEA and CDS registrations, board certifications, malpractice coverage, and other required credentials to ensure continuous compliance.
• Provide exceptional support to providers throughout the enrollment, credentialing, and licensing process by communicating requirements, timelines, and next steps clearly and proactively.

Licensing and Credentialing Specialist managing provider enrollments and compliance at a virtual health practice

Licensing and Credentialing Specialist

Licensing and Credentialing Specialist at Oshi Health managing payer enrollment and compliance. Collaborating with operational teams to ensure providers are credentialed and ready to deliver care.

• Reviews and processes applications for provider privileges
• Focuses on follow-up, follow through and achievement of stringent deadlines
• Reviews and analyzes provider credentialing file for completeness, accuracy, issues, and changes
• Responds to provider inquiries received by letter, phone, or internal departments
• Administers re-credentialing of Physicians and CRNAs
• Complies with HIPAA regulations
• Assists with other special projects and process redesign initiatives as requested

Credentialing Specialist managing provider applications at Pelvic Rehabilitation Medicine

Credentialing Specialist reviewing and processing applications for provider privileges at Pelvic Rehabilitation Medicine. Ensuring compliance with HIPAA regulations and administrative tasks.

Credentialing Specialist jobs in Florida

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Credentialing Specialist – Full Time, Day Shift

Credentialing Specialist

Medical Credentialing Specialist

Licensing and Credentialing Specialist

Credentialing Specialist