Provider Credentialing Specialist Job at Pomelo Care

Credentialing Specialist

Aria Care Partners is the national leader in providing onsite dental, vision, he...

Location

United States , Overland Park

Salary:

Not provided

Aria Care Partners

Expiration Date

Until further notice

Requirements

Minimum two years of health insurance credentialing experience preferred
Prior data management/data integrity experience preferred
Associates degree preferred
Proficient with Microsoft Office, including Excel, Word, and Outlook

Job Responsibility

Prepare and submit credentialing applications and supporting documentation for the purpose of enrolling groups and providers with Commercial, Medicare, and Medicaid networks
Follow up on the status of applications for providers with payers, tracking progression of pending and completed work
Maintains accurate and up-to-date database of information including provider credentials and payer statuses
Works closely with internal teams to communicate approvals and work through denials as necessary
Maintains knowledge of current payer requirements across multiple states and service lines
Maintain strict level of confidentiality and HIPAA compliance
Familiarity with state licensing requirements and provider onboarding tasks
Familiarity with various payer portals and CAQH
Contact providers and payers, by phone or email, for updates and/or to request missing information
Ensure group and provider information is current/accurate with health insurance payers

What we offer

PTO and Paid Holidays for FT Employees
401k Retirement Plan with Company Match
Insurance programs including medical, dental, vision, company match for your HSA, FSA, company-paid EAP, and life and disability insurance, and more

Fulltime

Credentialing Specialist I - Medical Staff

Location

United States , Tucson

Salary:

Not provided

Tucson Medical Center

Expiration Date

Until further notice

Requirements

High school diploma or general education degree (GED), or an equivalent combination of relevant education and experience
None required. One (1) year experience performing medical staff credentialing or similar related tasks preferred
None required
Knowledge and ability to understand what credentialing of medical health care providers entails
Knowledge and ability to understand, policy and procedures, regulations, statues, and laws as it relates to documents required for credentialing
Ability to organize and prioritize all assigned tasks and workloads in a busy work environment
Ability to brief leadership in a timely manner on status of workload, projects, priorities, barriers, or issues to ensure assignments are on track
Skill in the use of Microsoft Office products, especially Word and EXCEL
Ability to review and monitor various forms of detailed credentialing information to ensure compliance with departmental procedures
Ability to draft reports, business correspondence, and procedure manuals

Job Responsibility

Verifies medical training, experience and other attributes required of medical health care providers. Ensures the completion of files and monitors expired documents during the members' appointment period
Assists Credentialing Specialists and Leadership with the credentialing and recredentialing process
Reviews applications and other data for accuracy and completeness
Performs and collects primary source verification and other documents needed including follow-up activities of initial and reappointments applications
Enter credentialing and privileging data timely and accurately into the credentialing database
Ensures good working relationships with clinical departments, Medical Staff leadership and professional agencies
Assists in compliance with the accrediting and regulatory agencies regarding credentialing, while developing and maintaining a working knowledge of the required statutes and laws
Answers phones, assist with committee support, make copies, prepare mailings, and maintain files
Adheres to TMCH organizational and department-specific safety, confidentiality, values, policies, and standards
Performs related duties as assigned

Fulltime

Credentialing Specialist

We are seeking an experienced Credentialing Specialist to assist with a credenti...

Location

United States , Indianapolis

Salary:

Not provided

Robert Half

Expiration Date

Until further notice

Requirements

Previous healthcare credentialing experience
Hands-on experience performing Primary Source Verification (PSV)
Experience reviewing and maintaining provider credentialing files
Knowledge of credentialing compliance and regulatory requirements
Strong attention to detail and organizational skills
Ability to work independently and manage a high-volume workload
Proficiency with data entry and credentialing software/systems

Job Responsibility

Perform Primary Source Verification (PSV) for initial and recredentialing provider files
Review, audit, and maintain provider credentialing files to ensure accuracy and completeness
Verify provider licenses, certifications, education, training, work history, and other required credentials
Ensure all credentialing documentation meets regulatory, accreditation, and organizational compliance standards
Support the credentialing team in processing a high volume of backlog files
Conduct outbound calls to providers, facilities, and verification sources as needed
Perform accurate data entry and maintain credentialing records within designated systems
Follow established credentialing policies, procedures, and turnaround time requirements

What we offer

medical
vision
dental
life and disability insurance
401(k) plan

Fulltime

Credentialing Specialist

We are looking for a Credentialing Specialist to support provider and clinic sta...

Location

United States , Fresno

Salary:

Not provided

Robert Half

Expiration Date

Until further notice

Requirements

At least 3 years of experience in credentialing, provider enrollment, physician credentialing, or recredentialing operations
Demonstrated knowledge of credentialing workflows, application processing, and document management for licensed clinical professionals
Familiarity with California regulatory expectations and common payer, agency, and accreditation requirements related to provider credentialing
Experience maintaining accurate provider records, tracking expirations, and managing deadlines across multiple files or databases
Ability to work effectively with providers, leadership, health plans, agencies, and external facilities to resolve credentialing matters
Strong organizational skills and close attention to detail, with the ability to handle confidential information appropriately
Proficiency with online credentialing systems, database updates, and verification processes
Clear written and verbal communication skills for follow-up, coordination, and status reporting

Job Responsibility

Manage end-to-end credentialing, recredentialing, and privileging activities for providers and clinical staff, ensuring records remain complete and current
Prepare, submit, and monitor credentialing applications, following up with health plans, facilities, and agencies to keep approvals moving forward
Maintain organized documentation for licenses, certifications, malpractice coverage, and other required compliance materials for all applicable providers
Monitor expiration dates for licenses, certifications, liability coverage, and related credentials, and coordinate timely renewals to avoid lapses
Update and maintain provider profiles within credentialing platforms and internal databases, ensuring data accuracy across systems and directories
Coordinate renewal appointments for clinic staff and track required timelines to support uninterrupted compliance
Process privileging and reappointment requests for affiliated healthcare facilities when needed and verify supporting documentation
Review provider listings and directory information for accuracy, correcting demographic and practice location details with payers and partner entities as necessary
Provide credentialing and privileging verifications and assist with audits, accreditation activities, and other compliance-related assignments
Participate in training and carry out additional duties as assigned while demonstrating efficient use of time and resources

What we offer

medical
vision
dental
life and disability insurance
401(k) plan

Credentialing Specialist

We are seeking a Credentialing Specialist for a short term contract in Nashville...

Location

United States , Nashville

Salary:

Not provided

Robert Half

Expiration Date

Until further notice

Requirements

High school diploma or equivalent (Associate’s or Bachelor’s degree in Healthcare Administration or related field preferred)
1–3 years of experience in healthcare credentialing, provider enrollment, or medical staff services
Knowledge of payer enrollment processes (Medicare, Medicaid, commercial payers)
Familiarity with credentialing standards and regulatory requirements
Proficiency with credentialing software, provider databases, and Microsoft Office (Excel, Word, Outlook)
Strong organizational skills with high attention to detail
Excellent written and verbal communication skills

Job Responsibility

Coordinate and process initial credentialing, recredentialing, and payer enrollment for healthcare providers
Collect, verify, and maintain provider documentation including licenses, certifications, education, training, work history, NPIs, and DEA registrations
Prepare and submit credentialing and enrollment applications to insurance payers, hospitals, and regulatory bodies
Monitor credential expirations and proactively manage renewals to maintain continuous provider eligibility
Maintain accurate and up‑to‑date credentialing records in credentialing software and internal databases
Serve as a liaison between providers, payers, medical staff offices, and internal departments
Track application statuses, follow up on outstanding items, and resolve credentialing or enrollment issues
Ensure compliance with CMS, NCQA, Joint Commission, state, and payer credentialing requirements
Support audits and accreditation reviews by preparing and providing credentialing documentation
Maintain strict confidentiality of sensitive provider information

What we offer

medical
vision
dental
life and disability insurance
401(k) plan

Credentialing Specialist

We are seeking a detail-oriented and highly organized Credentialing Specialist t...

Location

United States , Atlanta

Salary:

Not provided

Aylo Health

Expiration Date

Until further notice

Requirements

High school diploma or equivalent
5-7 years of experience in provider credentialing, provider enrollment, or healthcare administration
Strong knowledge of credentialing processes and primary source verification
Experience working with health plans, hospitals, and provider networks
Proficiency with credentialing software, databases, and online verification systems
Excellent attention to detail, organization, and time management skills
Strong written and verbal communication skills

Job Responsibility

Collect, review, and process initial and re-credentialing applications for healthcare providers
Ensure applications are complete, accurate, and submitted within required payer and regulatory timelines
Serve as a primary point of contact for providers regarding credentialing requirements, status updates, and follow-up items
Track application progress and proactively follow up with providers, payers, hospitals, and facilities
Perform and document primary source verification for provider credentials
Complete credentialing, re-credentialing, and privileging processes to ensure providers are credentialed and appointed with health plans and payers, hospitals and health systems, patient care facilities and networks
Prepare credentialing files for review by Credentialing Committees
Issue approval, denial, or deficiency communications
Ensure compliance with federal and state regulations, payer requirements, and accreditation standards
Maintain knowledge of current health plan and agency credentialing requirements

What we offer

Competitive compensation
Comprehensive benefits package
Supportive, collaborative team environment
Opportunity to work in a mission-driven healthcare organization
Professional growth and development opportunities

Fulltime

Credentialing Specialist

We are looking for a Credentialing Specialist to support provider enrollment and...

Location

United States , Rochester

Salary:

Not provided

Robert Half

Expiration Date

Until further notice

Requirements

Experience working in credentialing, provider enrollment, or a related healthcare administrative function
Knowledge of credentialing workflows, reappointment cycles, and documentation standards within a regulated environment
Proficiency with Adobe Acrobat and confidence handling electronic forms and document management tasks
Familiarity with CAQH, EHR systems, CRM platforms, and database-driven recordkeeping
Understanding of auditing practices and compliance expectations tied to healthcare credentialing activities
Strong organizational skills with the ability to manage multiple deadlines and maintain precise records
Effective written and verbal communication skills for coordinating with providers, payers, and internal teams

Job Responsibility

Review, organize, and process provider credentialing and recredentialing files to support timely approvals and renewals
Verify licenses, certifications, work history, and other required documentation to ensure provider records meet healthcare and compliance standards
Maintain accurate information in credentialing databases, CRM tools, EHR systems, and related tracking platforms
Prepare audit-ready files by monitoring missing items, updating records, and following up with providers or internal stakeholders as needed
Use CAQH and other credentialing resources to validate provider data and streamline application management
Generate and manage digital documents using Adobe Acrobat, ensuring forms are complete, accurate, and properly stored
Support compliance reviews by identifying discrepancies, escalating issues, and helping enforce established credentialing procedures
Coordinate with cross-functional departments to track application status, resolve documentation gaps, and maintain efficient workflow progress

What we offer

Medical
vision
dental
life and disability insurance
401(k) plan

Fulltime

Credentialing Specialist

We are looking for a Credentialing Specialist to support provider enrollment and...

Location

United States , Plainview

Salary:

Not provided

Robert Half

Expiration Date

Until further notice

Requirements

Prior experience in medical credentialing, provider enrollment, healthcare administration, or a closely related field
Working knowledge of physician or provider credentialing, including initial credentialing and re-credentialing processes
Strong organizational skills with a high level of accuracy when reviewing sensitive records and documentation
Ability to communicate clearly with providers, administrators, and cross-functional stakeholders
Comfortable using web-based systems, databases, and credentialing applications in a structured setting
Capacity to manage multiple assignments, monitor deadlines, and adjust priorities as needed
Familiarity with healthcare compliance standards, licensing requirements, and credentialing regulations is preferred

Job Responsibility

Manage credentialing activities from initial intake through renewals and periodic reappointments for healthcare providers across multiple practices
Examine licenses, certifications, education records, training details, and employment history to confirm accuracy and completeness
Maintain organized and up-to-date provider information within a secure web-based credentialing platform
Partner with physicians, providers, and practice contacts to collect missing documents and resolve inconsistencies in submitted materials
Track application progress and follow up proactively to support timely completion and adherence to required deadlines
Apply current regulatory and accreditation guidelines to daily credentialing work and escalate issues when compliance concerns arise
Prepare recurring updates and summary reports for leadership and compliance stakeholders regarding credentialing status and outstanding items
Serve as a knowledgeable resource for credentialing-related questions across affiliated practices and internal teams

What we offer

medical
vision
dental
life and disability insurance
401(k) plan

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Provider Credentialing Specialist

Job Description

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