Credentialing Specialist

The Smilist; United States; Remote; USD 65,000 - 75,000; Full time

Job summary

The Smilist is seeking a Credentialing Specialist to manage credentialing and re-credentialing for healthcare providers, ensuring regulatory compliance and accurate records.

The role requires exceptional attention to detail, high organization, and strong communication as you verify licenses, maintain credentialing databases, track expirations, and coordinate with licensing boards and internal teams.

This remote US-based position offers a salary range of $65,000–$75,000 per year.

Qualifications

• 2+ years of credentialing or medical staff services experience.
• Knowledge of NCQA, URAC, Joint Commission and relevant regs.
• Detail-oriented with excellent time-management.
• Strong communication and interpersonal skills.

Responsibilities

• Credentialing & re-credentialing: verify qualifications, licenses, education, work history and other credentials.
• Verification & Compliance: conduct primary source verification and ensure adherence to standards.
• Database & Record Maintenance: keep provider information current in credentialing systems and audit files.
• Communication & Coordination: serve as main point of contact for providers and coordinate with internal teams.
• Reporting & Documentation: prepare reports on credentialing metrics and document activities per policy.

Skills

Attention to detail

Organizational skills

Time management

Communication

Interpersonal skills

Regulatory knowledge

Education

Associate's or Bachelor's degree in Healthcare Administration, Business Administration, or related field

Job description

The Credentialing Specialist is responsible for managing the credentialing and re-credentialing processes for healthcare providers to ensure compliance with organizational and regulatory standards. This role involves the verification of provider credentials, licenses, and professional qualifications, as well as maintaining accurate records and databases. The ideal candidate is detail-oriented, highly organized, and skilled in managing documentation and deadlines.

Duties and Responsibilities

• Credentialing & Re-credentialing:
  • Conduct thorough credentialing and re-credentialing processes for new and existing providers, verifying qualifications, licenses, certifications, education, work history, and other relevant credentials.
  • Ensure compliance with regulatory, accrediting, and internal requirements for credentialing documentation.
  • Track and manage all credential expirations and renewals to maintain up-to-date provider files.
• Verification & Compliance:
  • Verify credentials through primary source verification, including contacting educational institutions, licensing boards, and previous employers.
  • Ensure credentialing activities adhere to standards set by accrediting bodies (e.g., NCQA, URAC, Joint Commission) and state/federal regulations.
  • Identify and resolve any discrepancies or potential compliance risks during the credentialing process.
• Database & Record Maintenance:
  • Maintain accurate provider information in credentialing databases and systems, ensuring records are current and organized.
  • Track credentialing status, license expirations, and renewals, and document updates in the database.
  • Regularly audit credentialing files to ensure compliance with policies and maintain a high standard of record accuracy.
• Communication & Coordination:
  • Act as the main point of contact for providers during the credentialing process, answering questions, providing guidance, and offering status updates.
  • Collaborate with internal teams, such as recruitment, HR, and medical staff services, to support a smooth onboarding and credentialing process.
  • Communicate effectively with external organizations, including licensing boards, educational institutions, and accreditation agencies, for timely verifications.
• Reporting & Documentation:
  • Prepare and maintain reports on credentialing metrics, such as application status, processing times, and compliance rates.
  • Document all credentialing activities, communications, and decisions in line with regulatory requirements and company standards.
  • Assist in updating credentialing policies and procedures to improve processes and ensure compliance.

Qualifications:

• Associate’s or Bachelor’s degree in Healthcare Administration, Business Administration, or related field (or equivalent experience).
• 2+ years of experience in credentialing, medical staff services, or a related role in a healthcare setting.
• Knowledge of credentialing standards (NCQA, URAC, Joint Commission) and federal and state regulations.
• Excellent attention to detail, organizational, and time-management skills.
• Strong communication and interpersonal skills, with the ability to work effectively with internal teams and external contacts.

Preferred Skills:

• Certification as a Certified Provider Credentialing Specialist (CPCS) or Certified Professional in Medical Services Management (CPMSM) is a plus.
• Experience in the Dental Industry
• Familiarity with credentialing software or systems (e.g., CAQH, Echo, Healthstream, or symplr).
• Background in healthcare administration or medical office experience.

Salary - $65,000-$75,000
This is a remote position.