Provider Credentialing Specialist

Point32Health, Inc.; Milton (MA); On-site; USD 52,000 - 60,000; Full time

Job summary

Point32Health, Inc. is seeking a Credentialing Specialist to ensure physicians and independent practitioners meet health plan criteria and regulatory standards.

The role focuses on credentialing data integrity, license verification, and timely processing aligned with NCQA guidelines. Responsibilities include managing credentialing applications, NPDB screening, and supporting daily reviewer processes while collaborating with the Medical Director and Supervisors to resolve issues and ensure

Qualifications

• A minimum of a high school diploma is required.
• Bachelor’s degree is preferred.
• 1-2 years of experience in healthcare is required.
• Experience with provider credentialing is preferred.
• Knowledge of Word and Excel is recommended.

Responsibilities

• Maintain and process credentialing information for new and established providers.
• Enter initial and existing credentialing applications into the credentialing information system (Cactus).
• Verify licenses, board certifications, and related documentation.
• Review NPDB reports and state/federal sanctions as applicable.
• Prepare files for credentialing reviews and for QOCC presentations.
• Collaborate with Credentialing Supervisor on complex issues and regulatory requirements.

Skills

Emergency protocol

Credentialing system

Multi-tasking

Adaptability

Education

High school diploma

Bachelor’s degree

Tools

MS Word

MS Excel

Job description

Point32Health, Inc. is seeking a Credentialing Specialist to ensure physicians and independent practitioners meet health plan criteria and regulatory standards.

The role focuses on credentialing data integrity, license verification, and timely processing aligned with NCQA guidelines. Responsibilities include managing credentialing applications, NPDB screening, and supporting daily reviewer processes while collaborating with the Medical Director and Supervisors to resolve issues and ensure