Credentialing Specialist

3WON, LLC; Dallas (TX); On-site; USD 42,000 - 66,000; Full time

Job summary

3WON, LLC in Dallas, TX is seeking a credentialing specialist to verify and maintain healthcare providers' qualifications, ensuring licensure, board certifications, and compliance with federal and state regulations.

The role includes reviewing applications, verifying education and work history, and using credentialing software; strong attention to detail and confidentiality are essential; remote work experience is valued.

Qualifications

• High school diploma or equivalent required.
• Associate's or Bachelor's degree preferred.
• Minimum 3 years credentialing experience in healthcare settings.
• At least 1 year of experience with credentialing software.
• Strong communication and ability to handle confidential information.

Responsibilities

• Collect, verify, and process the credentials of providers.
• Review applications for regulatory compliance and accuracy.
• Ensure data is accurately entered into credentialing systems.
• Handle initial and reappointment credentialing per client guidelines.
• Maintain knowledge of Joint Commission, NCQA, and related standards.

Skills

Credential verification

Attention to detail

Regulatory compliance

Communication skills

Data entry accuracy

Education

High school diploma or equivalent

Associate's or Bachelor's degree preferred

Tools

Credentialing software

Job description

POSITION SUMMARY

A credentialing specialist is responsible for verifying and maintaining the qualifications and credentials of healthcare professionals to ensure compliance with industry standards, regulatory requirements, and client policies. This role is crucial in ensuring that medical providers are properly licensed, certified, and trained to deliver safe and effective care.

ESSENTIAL FUNCTIONS:

The credentialing specialist is responsible for collecting, verifying, and processing the credentials of providers. This includes reviewing applications, ensuring compliance with legal and regulatory requirements, and ensuring accurate and timely data into credentialing systems.

• Responsible for credentialing initial and reappointment applications based on client guidelines
• Verify the educational background, licensure, board certifications, work history, and references of providers.
• Ensure that all credentials meet the standards set by client policies, regulations, and the industry.
• Ensure compliance with federal, state, and organizational regulations, including those from The Joint Commission, AAAHC, and/or NCQA.
• Performs miscellaneous job-related duties as assigned.

POSITION QUALIFICATIONS

Education:

• High school diploma or equivalent required
• Associate's or Bachelor's degree preferred

Experience:

• A minimum of 3 years' experience directly related to medical provider credentialing in a hospital, managed care, or medical practice environment
• A minimum of 1 year experience with credentialing software

Other Skills:

• A minimum 1 year of remote work experience
• Strong attention to detail and ability to handle sensitive information confidentially
• Excellent organizational and time management skills
• Ability to manage multiple tasks in a fast-paced environment
• Strong communications skills (both orally and in writing) to interact with providers, clients, and colleagues.
• Knowledge of medical terminology and healthcare accreditation standards