Credentialing Specialist: Elevate Provider Quality & Compliance

Prominence Health; Reno (NV); On-site; USD 50,000 - 75,000; Full time

Benefits offered by this job

Loan Forgiveness Program

Competitive compensation & generous PT

Excellent Medical, Dental, Vision and

401(K) with company match

SoFi Student Loan Refinancing Program

Career development opportunities

Job summary

Prominence Health is seeking a Credentialing Specialist responsible for thorough investigations of background and credentials for all practitioners and facilities contracted to provide care to Health Plan members. You will oversee primary source verification and ensure discrepancies are clarified, with reporting to the Medical Director and Plan Credentialing Committee.

This role ensures compliance with State, Federal and NCQA/CMS accreditation standards, delivering accurate credentialing

Qualifications

• High school diploma or equivalent.
• 1–3 years related experience; credentialing experience preferred.
• Strong English communication, verbal and written.
• Detail oriented with strong organizational skills.

Responsibilities

• Investigate background and credentials for practitioners and facilities contracted to provide care to Health Plan members.
• Direct and oversee primary source verification of credentialing elements.
• Summarize and report results to Medical Director and Credentialing Committee; provide written follow-up as required.
• Ensure processes comply with State, Federal and NCQA/CMS accreditation standards.

Skills

Communication skills

Attention to detail

Organizational skills

English proficiency

Education

High school diploma

1–3 years experience

Tools

MS Office

Job description

Prominence Health is seeking a Credentialing Specialist responsible for thorough investigations of background and credentials for all practitioners and facilities contracted to provide care to Health Plan members. You will oversee primary source verification and ensure discrepancies are clarified, with reporting to the Medical Director and Plan Credentialing Committee.

This role ensures compliance with State, Federal and NCQA/CMS accreditation standards, delivering accurate credentialing