Provider Credentialing & Data Compliance Specialist

Provider Partners; United States; On-site; USD 52,000 - 78,000; Full time

Job summary

Provider Partners is seeking a Credentialing Specialist to verify credentials and manage provider data for network participation. You will ensure compliance with regulatory standards and maintain accurate information across systems.

Responsibilities include primary source verification, handling inquiries, updating files, and audits to ensure CMS and NQA compliance. Strong Excel skills and Salesforce expertise are valued.

Qualifications

• Education and experience align with credentialing operations.
• Proven ability to manage provider data and comply with regulatory standards.

Responsibilities

• Analyze credentialing applications for primary source verification and determine network eligibility.
• Respond to inquiries about provider participation, eligibility, credentialing, and file updates.
• Maintain provider files, Salesforce workflow, and electronic records with current data.

Skills

Excel

Pivot tables

Communication

Interpersonal skills

Education

High School Diploma

Bachelor’s Degree in Business/Healthcare Admin or related field

Tools

Salesforce

Job description

Provider Partners is seeking a Credentialing Specialist to verify credentials and manage provider data for network participation. You will ensure compliance with regulatory standards and maintain accurate information across systems.

Responsibilities include primary source verification, handling inquiries, updating files, and audits to ensure CMS and NQA compliance. Strong Excel skills and Salesforce expertise are valued.