Credentialing Specialist

Upstream Rehabilitation Inc.; Phoenix (AZ); Remote; USD 42,000 - 62,000; Full time

Benefits offered by this job

Annual paid Charity Day

100% employer paid medical health保险

100% employer paid medical health保险

Job summary

Upstream Rehabilitation Inc., via Preferred Therapy Partners, seeks a Credentialing Specialist to support initial credentialing and recredentialing for network practitioners. You will collect and verify practitioner information, perform primary source verification, and maintain credentialing records.

You will monitor licensure and certification requirements, track expirations, and coordinate with health plans and internal/external stakeholders while ensuring data privacy and regulatory

Qualifications

• High school diploma or equivalent.
• Strong attention to detail, self-motivation, and effective written and verbal communication skills.
• Demonstrated ability to establish and maintain positive working relationships with providers and staff.
• Proficiency in Microsoft Office (Word, Excel), Adobe Acrobat, and web-based systems.

Responsibilities

• Maintain practitioner credentialing records and perform verifications.
• Manage CAQH and paper applications for credentialing and recredentialing.
• Coordinate with health plans and internal/external stakeholders.
• Monitor licensure and certification requirements and renewal dates.
• Ensure privacy and security of credentialing data in accordance with policies.
• Cross-train and provide support in other functions as needed.

Skills

Attention to detail

Communication skills

Microsoft Office

Education

High school diploma or equivalent

Tools

Microsoft Word

Microsoft Excel

Adobe Acrobat

Web-based systems

Job description

Preferred Therapy Partners, a Brand Partner of Upstream Rehabilitation, is looking for a Credentialing Specialist to join our team!

Credentialing Specialist

Location Type: Remote - Arizona

Must Reside in the United States

Build Your Career with Us!

Upstream Rehabilitation is the country's largest dedicated provider of outpatient physical and occupational therapy services. Our mission is to inspire and empower the lives we touch, to serve our communities, and to lead with purpose-driven passion.

We are committed to delivering remarkable experiences and fostering an inclusive workplace where differences are valued and celebrated. With 1,200+ locations nationwide, 26 brand partners, and 8,000+ employees, Upstream operates at scale while leveraging data, technology, and innovation to drive smarter decisions and operational excellence across the organization.

The Role:

Join Preferred Therapy Providers, a brand partner of Upstream Rehabilitation, where your work makes a real impact! As a Credentialing Specialist, you will support the initial credentialing and recredentialing of practitioners within the Preferred Therapy Providers (PTP) network. This includes collecting and verifying practitioner information, conducting primary source verification, maintaining credentialing records, and coordinating with contracted health plans and internal and external stakeholders.

In this role, you will ensure practitioner data remains accurate and up to date, monitor licensure and certification requirements, and support credentialing activities in compliance with applicable regulations, accreditation standards, and company policies. Your attention to detail and commitment to quality will play a critical role in maintaining a high-performing provider network while advancing PTP's mission, vision, and values and contributing to the organization's continued growth and success.

What You'll Do:

• Maintain accurate and timely practitioner data, electronic files, and credentialing records within the credentialing database, ensuring information is entered, updated, and revised as needed.
• Access and manage practitioner information through CAQH and paper application systems to support credentialing and recredentialing activities.
• Provide administrative support for credentialing operations.
• Perform primary source verifications and maintain practitioner licensing, credentialing, certification, and insurance records, ensuring all documentation is accurate, current, and complete.
• Monitor license, certification, insurance, and continuing education requirements; track expiration and renewal dates; and maintain compliance with applicable organizational, regulatory, and accreditation standards.
• Communicate with internal stakeholders and external practitioners regarding application status, credentialing requirements, and outstanding documentation to support the timely completion of credentialing and recredentialing activities.
• Perform credentialing and recredentialing activities in accordance with applicable federal and state regulations, payer requirements, accreditation standards, and company policies and procedures.
• Monitor credentialing files and outstanding requirements, proactively identifying and escalating delays, deficiencies, or compliance concerns as appropriate.
• Maintain the confidentiality, integrity, and security of practitioner information and credentialing records in accordance with company policies and applicable regulatory requirements.
• Crosstrain and provide support in other functional areas as needed.
• Perform other projects and duties as assigned.

Who You Are:

• High school diploma or equivalent experience.
• Strong attention to detail, self-motivation, and effective written and verbal communication skills.
• Demonstrated ability to establish and maintain positive working relationships with providers, leadership, staff, and external partners.
• Proficiency in Microsoft Office applications, including Word and Excel, Adobe Acrobat, and web-based systems.
• Proven ability to organize and prioritize work, manage multiple responsibilities, and meet deadlines in a fast-paced environment.

Nice to Haves:

• Previous experience with healthcare credentialing, provider enrollment, revenue cycle operations, or other healthcare administrative functions.
• Experience supporting healthcare organizations, including physical therapy, rehabilitation, or related clinical settings.

Why You'll Love Working Here

• The chance to directly shape our organization's growth by hiring the talent that drives our mission.
• Opportunities to stretch your skills-whether you're building pipelines, designing sourcing strategies, or advising leadership.
• A collaborative team environment where your ideas are valued.
• Competitive compensation, comprehensive benefits, and ongoing professional development.

Benefit Offerings:

• Annual paid Charity Day to give back to a cause meaningful to you
• 100% employer paid medical health insurance premium option av