Medical Credentialing Specialist

Redefine Healthcare; Matawan (NJ); On-site; USD 70,000 - 85,000; Full time

Benefits offered by this job

Paid time off

Health insurance (medical, dental, etc

Life insurance

401(k) with company match

Yearly bonus

Job summary

Redefine Healthcare is seeking a Credentialing Specialist in Matawan, NJ. This full-time role oversees credentialing software and provider documentation, coordinating with internal teams and external payors.

The candidate will verify credentials, maintain records, and ensure regulatory compliance to support quality patient care. Salary ranges from $70,000 to $85,000 annually, with 40 hours per week and a comprehensive benefits package.

Qualifications

• Bachelor’s degree in healthcare administration or related field preferred.
• Minimum 2–4 years of credentialing experience, healthcare setting preferred.
• Solid experience with credentialing software and databases.
• Knowledge of payor credentialing, regulatory standards, and compliance.

Responsibilities

• Oversee initial and re-credentialing applications for healthcare providers.
• Verify licenses, certifications, education, training, and work history.
• Maintain credentialing records and databases.
• Ensure compliance with accreditation standards and regulatory requirements.
• Prepare and submit credentialing applications to insurance entities and payors.
• Collaborate with internal departments to facilitate provider onboarding.

Skills

Credentialing experience

Attention to detail

Regulatory compliance

Communication with boards

Education

Bachelor’s degree in healthcare administration / related field

CPCS Certification (Preferred)

Tools

Medallion software

Job description

If you are unable to complete this application due to a disability, contact this employer to ask for an accommodation or an alternative application process.

Medical Credentialing Specialist

Matawan, NJ, US

30+ days ago Requisition ID: 1038

Salary Range: $70,000.00 To $85,000.00 Annually

At Redefine Healthcare, we believe in providing all patients with the highest quality of care and compassion. With our dedicated team of Neurosurgeons, Interventional Pain Management Specialists, Orthopedists, Psychiatrists, Vascular Surgeons, Physical Therapists, and Chiropractors, we pride ourselves on specializing in superior continuity of care for our patients.

Redefine Healthcare is looking for a full-time Credentialing Specialistto join our expanding team of professionals in our Matawan, NJ office. You will be responsible for the oversight of our credentialing software, provider documentation, and processes for our healthcare providers with both the organization and its payors. The right candidate will be thoroughly knowledgeable with all aspects of credentialing, including payor credentialing, have initiative and a great work ethic, and looking to advance their career in a community that is always growing.

Job Title: Credentialing Specialist

Salary/Pay Rate: $70,000 - $85,000, based on knowledge and experience

Hours: 40 hours per week

Job Type : Full-time

Benefits: Paid time off, sick time, health insurance (medical, dental, vision, accident, and critical illness), life insurance, 401(k) with Company match, yearly bonus.

Responsibilities (include, but not limited to):

• Oversee initial and re-credentialing applications for healthcare providers.
• Verify provider credentials, including licenses, certifications, education, training, and work history.
• Maintain up-to-date records and databases of provider credentials.
• Ensure compliance with accreditation standards and regulatory requirements.
• Collect, review, and verify all necessary documentation from providers.
• Communicate with licensing boards and other entities to confirm the accuracy of credentials.
• Liaise with outsourced credentialing team.
• Assist in the preparation and submission of credentialing applications to insurance companies, managed care organizations, and other relevant bodies.
• Act as a resource to the billing team when claim denial reasons are related to enrollment, contracting and/or credentialing.
• Monitor and ensure adherence to all federal, state, and organizational credentialing requirements and standards.
• Conduct routine audits of credentialing files and documentation to ensure accuracy and compliance.
• Stay current with changes in credentialing regulations and policies.
• Serve as a point of contact for providers regarding credentialing inquiries and issues.
• Collaborate with internal departments, such as Human Resources and Medical Staff Services, to facilitate provider onboarding and credentialing processes.
• Provide support and training to internal staff on credentialing procedures and requirements.
• Prepare and maintain detailed reports on credentialing status, pending applications, and compliance issues.
• Ensure timely completion of credentialing tasks and meet all deadlines for submissions and renewals.

Minimum Level of Education or Experience Required:

• Bachelor’s degree in healthcare administration, Business Administration, or a related field preferred.
• Medallion software experience is a plus
• CPCS Certified (Preferred)
• Minimum of [2-4] years of experience in credentialing or a related field, preferably within a healthcare setting.
• Solid experience with credentialing software and databases.
• Strong understanding of healthcare credentialing processes, standards, and regulations.
• Ability to handle sensitive and confidential information with discretion.