Healthcare Credentialing Specialist - Compliance & Network

MCS Puerto Rico; San Juan (PR); On-site; USD 42,000 - 62,000; Full time

Job summary

MCS Puerto Rico is seeking a Credentialing Specialist to manage credentialing and recredentialing across the provider network. You will ensure regulatory and accreditation compliance while maintaining data integrity and timely updates.

The role requires coordinating verifications, presenting files to the Credentialing Committee, and serving as a liaison to providers. On-site inspections and document management are key duties.

Qualifications

• Bachelor’s Degree in Business Administration, Healthcare Administration, or related fields.
• Associate’s Degree or at least 60–64 college credits. Four years of experience in credentialing or provider network operations.

Responsibilities

• Evaluates credentialing and recredentialing applications for completeness and adherence with standards.
• Performs primary and secondary source verifications (NPDB, CMS Preclusion, OIG, EPLS, licensing boards).
• Investigates discrepancies, coordinates follow-up actions, and ensures files are complete before committee review.
• Assigns credentialing levels (Level I/II) based on risk and provider type for committee review.
• Tracks expiring credentials and maintains monitoring logs for compliance.

Skills

Credentialing

Provider network operations

Monitoring & reporting

Education

Bachelor’s Degree in Business Administration, Healthcare Administration, or related fields

Associate’s Degree or 60–64 college credits

Job description

MCS Puerto Rico is seeking a Credentialing Specialist to manage credentialing and recredentialing across the provider network. You will ensure regulatory and accreditation compliance while maintaining data integrity and timely updates.

The role requires coordinating verifications, presenting files to the Credentialing Committee, and serving as a liaison to providers. On-site inspections and document management are key duties.