Credentialing Specialist

Job Summary

A company is looking for a Credentialing Specialist to coordinate and perform credentialing functions.

Key Responsibilities

• Complete primary source verification and file review of practitioner credentialing files
• Maintain compliance with NCQA guidelines and assist in training staff on these standards
• Coordinate the NCQA accreditation process and ensure accuracy in provider directory information

Required Qualifications

• Bachelor's degree in a healthcare-related field
• CPCS Certification preferred
• Two to three years of provider credentialing experience, particularly with NCQA and HIPAA
• Experience in managing client relationships with external regulatory and compliance partners
• Strong project management skills and ability to meet strict deadlines