Healthcare Credentialing Specialist

Arbour SeniorCare; Reno (NV); On-site; USD 60,000 - 90,000; Full time

Benefits offered by this job

Loan Forgiveness Program

Generous PTO

Medical, Dental, Vision and Rx Plans

401(K) with company match

SoFi Student Loan Refinancing Program

Career development opportunities with

Career development opportunities with

Job summary

Prominence Health is seeking a Credentialing Specialist to thoroughly investigate backgrounds and credentials for practitioners and facilities contracted to Health Plan members. You will oversee primary source verification, ensure accuracy, and report findings to the Medical Director and Credentialing Committee.

Role emphasizes compliance with state, federal, and NCQA/CMS accreditation standards, with a focus on confidentiality and timely processing in a value-based care environment.

Qualifications

• High school diploma or equivalent required.
• 1–3 years related experience in credentialing or medical staff office preferred.
• Strong English communication skills, verbal and written.
• Highly detail oriented with organizational and prioritization abilities.
• Experience in physician office or medical care settings desirable.
• CREDENTIALING experience strongly preferred.
• Proficient computer skills: word processing, databases, spreadsheets.
• Excellent interpersonal written and oral communication skills.
• Strong medical terminology recommended.
• Ability to prioritize multiple tasks per protocols and timelines.
• Customer service focus within a team-oriented department.
• Motivated, flexible, self-starter with problem-solving skills.

Responsibilities

• Investigate credentials and background for practitioners and facilities contracted to Health Plan members.
• Oversee primary source verification and clarify discrepancies found in the process.
• Summarize results in reports to Medical Director and Credentialing Committee with follow-up as required.
• Ensure processes comply with state, federal, NCQA and CMS accreditation standards.

Skills

English communication

Attention to detail

Organization

Time management

Confidentiality

Customer service

Education

High school diploma or equivalent

Tools

Word processing

Databases

Spreadsheets

Graphics

Job description

Prominence Health is seeking a Credentialing Specialist to thoroughly investigate backgrounds and credentials for practitioners and facilities contracted to Health Plan members. You will oversee primary source verification, ensure accuracy, and report findings to the Medical Director and Credentialing Committee.

Role emphasizes compliance with state, federal, and NCQA/CMS accreditation standards, with a focus on confidentiality and timely processing in a value-based care environment.