Credentialing Specialist

Trusted Medical PLLC; New Bern (NC); Hybrid; USD 52,000 - 57,000; Full time

Job summary

Trusted Medical PLLC is seeking a credentialing specialist to bridge vendor tech and clinical operations, validating system performance and optimizing workflows in credentialing.

The role requires deep knowledge of NCQA, CMS, and payer rules, with 3+ years in credentialing and strong communication skills. Travel up to 25% is required; hybrid work in DC area offered, with base salary in the range shown.

Qualifications

• 3+ years in healthcare credentialing or provider enrollment.
• VA and/or DoD credentialing experience is strongly preferred.
• Experience ensuring compliance with regulatory standards and interacting with payers or government entities.
• Proven ability to manage credentialing data and documentation systems effectively.
• Demonstrated expertise in streamlining credentialing processes with accelerated turnaround times, enabling onboarding.

Responsibilities

• Manage end-to-end credentialing process including enrollment, initial credentialing, and re credentialing.
• Conduct primary source verification of credentials (licenses, DEA, board certifications, education, work history).
• Track expiration of licenses, credentials, malpractice insurance, CME, and renewals; manage recredentialing timelines.
• Submit credentialing/enrollment applications to payers and follow up until in-network status confirmed.
• Ensure compliance with state/federal regulations, NCQA, TJC, CMS, and accrediting institutions.
• Assist in developing/improving internal credentialing policies and procedures.
• Respond to information requests from regulatory agencies or public inquiries as required.

Skills

Regulatory knowledge

Payer credentialing

Attention to detail

Organizational skills

Communication skills

Research skills

Willing to travel

Education

Bachelor’s degree in HIM/Healthcare Admin

CPCS certification

Tools

CAQH ProView

CredentialStream

PECOS

NPPES

NPDB queries

Job description

Trusted Medical provides high-quality, integrated care in your community.

Your health care needs are as unique as you are. Our pioneering approach brings world-class care directly to you. We are an innovative medical clinic that provides an extraordinary patient experience without compromise.

Our goal is simple: to deliver exceptional care to our patients while being trusted partners in our communities throughout the country.

Trusted Medical, an Edera affiliate, employs the most skilled clinicians to deliver an unparalleled health care experience. Our team of licensed providers consists of physicians and advanced practice providers. They are committed to delivering the highest quality of care to our patients in a dignified and respectful manner. Trusted Medical clinics currently feature a suite of offerings, including tailored assessments, innovation services, and comprehensive evaluation support.

You can count on Trusted Medical to deliver quality, direct health care, when you need it, how you need it, where you need it.

Position Description

The ideal candidate will serve as a subject matter expert capable of bridging the gap between vendor technology and clinical operations. They must possess a strong understanding of the product’s functionality and troubleshooting techniques, enabling them to validate system performance and identify issues. This includes evaluating current workflows, recognizing opportunities for optimization, and recommending improvements in either system design or operational processes. The candidate should have firsthand industry experience in Credentialing solutions and demonstrate deep familiarity with the application of electronic health records in that setting. They must work to resolve issues and change requests. They must be able to confidently lead discussions with diverse stakeholders, assess current-state workflows, and propose enhancements that consider both immediate needs and downstream impacts. Additionally, they should be adept at articulating changes to affected groups, integrating those insights into training content and communication strategies to support long-term success across future rollouts.
Applicants with VA and/or DoD experience are preferred, along with an active federal clearance or the ability to obtain one

Type of Employment: Full-time salaried and fully benefited position

Work Location/Travel: Hybrid in Washington, DC

Expected 25% travel required; applicants must be free from travel restrictions to accommodate evolving needs of the client.

Salary Range: $52,123 – 57,456 base salary , depending on experience .

Role Reports to: Clinical Capability Lead

Direct Reports: This role has no direct reports

Responsibilities:

• Manage end-to-end credentialing process including enrollment, initial credentialing, and re credentialing .
• Conduct primary source verification of credentials (licenses, DEA, board certifications, education, work history).
• Track expiration of licenses, credentials, malpractice insurance, CME, and renewals; manage recredentialing timelines.
• Submit credentialing/enrollment applications to payers and follow up until in ‑ network status confirmed .
• Ensure compliance with state/federal regulations, NCQA, TJC, CMS, and accrediting institutions.
• Assist in developing/improving internal credentialing policies and procedures.
• Respond to information requests from regulatory agencies or public inquiries as required.

Knowledge and Skills Required:

• Deep knowledge of healthcare regulatory requirements, credentialing standards (NCQA, TJC, CMS), and payer credentialing rules.
• Strong attention to detail and analytical skills to review applications, detect discrepancies, and resolve credentialing issues.
• Exceptional organizational and time-management skills, able to manage high volumes independently.
• Excellent written and verbal communication skills.
• Research-savvy, able to verify documentation across diverse systems and sources.
• Flexible and adaptable to frequent travel, with no restrictions on mobility.

Education/Certification Required:

• Bachelor’s degreein Health Information Management, Healthcare Administration, Business Administration, or a related field required.

Preferred - Education/Certification:

• CPCS (Certified Provider Credentialing Specialist) certification from NAMSS is highly preferred.

Experience Required:

• 3+ years in healthcare credentialing or provider enrollment (specialist or coordinator roles).
• VA and/or DoD credentialing experience is strongly preferred.
• Experience ensuring compliance with regulatory standards and interacting with payers or government entities.
• Proven ability to manage credentialing data and documentation systems effectively.
• Demonstrated expertise in streamlining credentialing processes with accelerated turnaround times, enabling candidates to onboard and begin work more quickly.
• Technical Skills Required

Technical Skills :

• Proficiency in MS Office suite; advanced Excel preferred.
• Familiarity with credentialing platforms: CAQH ProView, CredentialStream , PECOS, NPPES, NPDB queries.
• Experience using healthcare compliance databases and understanding of data entry best practices.

All applicants must be US citizens and able to obtain a Public Trust clearance. Trusted Medical, PLLC participates in the E-Verify program. Trusted Medical, PLLC is a drug-free workplace.

Trusted Medical, PLLC is an Equal Opportunity and Aff… Edera prohibits discrimination against individuals based on their race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other category protected by law. Edera takes affirmative action to employ and advance in employment individuals without regard to race, color, religion, sex, sexual orientation, gender identify, national origin, disability, or veteran status.