Credentialing & Privileging Specialist

CommUnityCare; Austin (TX); Hybrid; USD 52,000 - 76,000; Full time

Job summary

CommUnityCare is seeking a Credentialing Coordinator to manage credentialing and recredentialing processes for healthcare professionals across its Austin health centers.

Under the Credentialing Manager, you will verify credentials, maintain databases, and ensure compliance with CMS, NCQA, and Joint Commission standards while coordinating changes in privileges and demographics. This role supports HIPAA compliance and timely file processing.

Qualifications

• 2 years of practitioner credentialing experience with regulatory knowledge.
• Familiar with CMS, TJC, NCQA and accrediting bodies.
• Certified Professional Credentialing Specialist (CPCS) within 3 years of hire.
• Strong attention to detail, time management and communication skills.
• Ability to work in a fast-paced, potentially remote environment.

Responsibilities

• Reviews initial credentialing/recredentialing and privilege requests for completeness and compliance.
• Performs primary source verification of credentialing elements.
• Data entry of new applications into the credentialing database.
• Communicates with providers, credentialing reps, and leadership on updates.
• Analyzes discrepancies and resolves issues affecting credentialing.

Skills

Organizational skills

Communication

Time management

Problem solving

Attention to detail

MS Word

MS Excel

MS Access

CAQH knowledge

Medicare/Medicaid enrollment knowledge

Education

High School Diploma

Certified Professional Credentialing Specialist (CPCS)

Tools

CAQH

Credentialing database

Job description

CommUnityCare is seeking a Credentialing Coordinator to manage credentialing and recredentialing processes for healthcare professionals across its Austin health centers.

Under the Credentialing Manager, you will verify credentials, maintain databases, and ensure compliance with CMS, NCQA, and Joint Commission standards while coordinating changes in privileges and demographics. This role supports HIPAA compliance and timely file processing.