Provider Credentialing Specialist Job at Pomelo Care

Medical Staff Credentialing Specialist and Coordinator

The Medical Staff Credentialing Specialist and Coordinator assists the Medical D...

Location

United States , Medina

Salary:

50000.00 - 60000.00 USD / Year

Orleans Community Health

Expiration Date

Until further notice

Requirements

Associates Degree or Certified Provider Credentialing Specialist (CPCS)
A minimum of 2-3 Years Credentialing experience is preferred
Excellent verbal and written communication skills, ability to relate well with people of diverse backgrounds, training and experience
Proficiency with medical practice software programs, Familiarity with credentialing requirements of hospitals and insurance carriers
Understanding of Malpractice insurance coverages and policies
Knowledge and understanding of credentialing process
Ability to organize and prioritize work and manage multiply priorities
Ability to research and analyze data
Ability to work independently with minimal supervision
Ability to establish and maintain effective working relationships with providers, management, staff and external contacts

Job Responsibility

Compiles and maintains current and accurate data for all providers
Completes provider credentialing and re-credentialing applications, monitors applications and follow-up as needed
Maintains copies of current state licenses, DEA certificates, malpractice coverage and any other required credentialing documents for all providers
Maintains corporate provider contract files
Maintains knowledge of current health plan and agency requirements for credentialing providers
Sets up and maintains provider information in online credentialing databases and system
Tracks license and certification expirations for all providers to ensure timely renewals
Ensures practice addresses are current with health plans, agencies and other entities
Audits health plan directories for current and accurate provider information
Completes credentialing/re-credentialing application packets for hospital, insurance carriers and government programs

What we offer

vacation and sick time
health, dental and vision
pension and retirement plan
competitive wages, with superior pension and retirement plans with employer contributions
12% shift differential for working evening and night shifts
excellent vacation, holiday and sick leave package
tuition assistance
free parking

Fulltime

Credentialing Specialist

We are looking for a detail-oriented Credentialing Specialist to join our team o...

Location

United States , Henderson

Salary:

Not provided

Robert Half

Expiration Date

Until further notice

Requirements

Proven experience in credentialing, particularly in a healthcare or hospital setting
Proficiency in using credentialing databases, CRM systems, and EHR platforms
Familiarity with the Council for Affordable Quality Healthcare (CAQH) process
Strong knowledge of medical terminology and credentialing standards
Exceptional organizational and auditing skills with high attention to detail
Ability to manage multiple tasks and meet strict deadlines
Certified Provider Credentialing Specialist (CPCS) designation preferred
Proficiency in tools like Adobe Acrobat and Microsoft Office Suite

Job Responsibility

Manage the credentialing process by collecting, reviewing, and verifying applications and supporting documentation
Ensure all physician credentials are accurate, complete, and comply with applicable regulatory standards
Maintain up-to-date records in the credentialing database and other tracking systems
Collaborate with healthcare providers and organizations to resolve discrepancies or incomplete information
Conduct audits to verify compliance with internal policies and external regulatory requirements
Provide support for enrollment with the Council for Affordable Quality Healthcare (CAQH) and other accrediting bodies
Prepare detailed reports on credentialing activities and compliance status
Assist in identifying and implementing improvements to the credentialing process
Stay informed about changes in healthcare credentialing regulations and best practices

What we offer

medical, vision, dental, and life and disability insurance
eligible to enroll in our company 401(k) plan

Fulltime

Credentialing Specialist

We are in search of a skilled Credentialing Specialist to join our team in South...

Location

United States , Southborough

Salary:

Not provided

Robert Half

Expiration Date

Until further notice

Requirements

Minimum of 5 years experience as a Credentialing Specialist or a similar role in the healthcare industry
Proficiency in computerized billing systems and electronic health record (EHR) systems
Experience with Epic Software
Solid understanding and experience in accounting functions, specifically in the healthcare setting
Expertise in medical credentialing and medical billing is essential
Proficiency in Microsoft Excel
Demonstrated experience in handling various billing functions
Familiarity with contractual billing, electronic billing, healthcare billing, insurance billing, Medicaid billing, medical insurance billing, Medicare billing, patient billing, physician billing, and third-party billing

Job Responsibility

Collect, review, and validate credentials for healthcare providers, including licenses, certifications, and education
Maintain and update credentialing databases and files for all healthcare providers, ensuring all required documents are current and complete
Adhere to all applicable laws, regulations, and industry standards (e.g., NCQA, CMS, etc.) associated with credentialing
Generate and maintain reports related to credentialing status and compliance and communicate any issues or discrepancies to management
Assist with the enrollment of providers and group facilities into insurance networks and maintain active status with payer organizations
Act as a liaison between healthcare providers, insurance companies, and internal departments to resolve credentialing issues or questions
Participate in internal and external audits of credentialing files, ensuring accurate and timely completion of necessary documentation
Stay informed of changes in regulatory requirements and best practices to ensure the credentialing process remains efficient and compliant
Uphold the dignity and respect of individuals we support and ensure they are treated in accordance with our Human Rights policies
Adhere to all principles related to the Advocates Way

What we offer

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

Fulltime

Credentialing Specialist Lead

The Credentialing Specialist Lead serves as the senior subject matter expert wit...

Location

United States , Long Island City

Salary:

30.00 - 32.00 USD / Hour

The Dermatology Specialists

Expiration Date

Until further notice

Requirements

3+ years of healthcare credentialing experience
dermatology or multispecialty experience preferred
Strong knowledge of CAQH, NPPES, Medicaid, Medicare, and commercial payer portals
Exceptional attention to detail, organization, and follow-through
Excellent communication and interpersonal skills
Proficiency in Excel and credentialing systems
experience with eClinicalWorks a plus

Job Responsibility

Manage the full credentialing lifecycle for physicians, NPs, and PAs — including Medicaid, Medicare, and commercial payer enrollments (Empire BCBS, Fidelis, Aetna, etc.)
Review and verify provider documents such as medical licenses, DEA, board certifications, malpractice coverage, and CVs
Prepare, track, and submit enrollment applications accurately and within payer timelines
Monitor revalidation and re-credentialing schedules to ensure ongoing compliance
Serve as the primary point of contact for escalated payer or provider inquiries
Partner with internal billing and operations teams to ensure credentialing aligns with billing readiness
Maintain credentialing logs, dashboards, and internal trackers for reporting purposes
Assist in training and supporting new credentialing specialists, ensuring quality and consistency across workflows

Credentialing Specialist

The Credentialing Specialist will be responsible for timely submission and follo...

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
Excellent organization and communication skills
Quick thinking, positive, and professional, with demonstrated problem solving, attention to detail, and critical thinking skills
Ability to work independently, set priorities, and meet deadlines
Adapt to changes in work environment, manage competing demands and deal with frequent change, delays, or unexpected events
Able to work in a team environment

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

Client Partner – Credentialing Specialist

Join our team in Manila as a Client Partner - Credentialing Specialist. We are s...

Location

Philippines , Taguig City

Salary:

Not provided

Access Healthcare LLC

Expiration Date

Until further notice

Requirements

Strong knowledge of Payer Processes and Credentialing
Willingness to work continuously in night shifts
Must be fluent in English language
Willing to work in the night shift at our office in McKinley Hill, Taguig
Must have at least 1 year of experience in Credentialing processes for US healthcare customers

Job Responsibility

Manage the end-to-end provider enrollment process, ensuring healthcare providers are properly credentialed and enrolled with insurance networks
Conduct thorough review of provider documentation, ensuring compliance with credentialing requirements and proactively resolving any discrepancies
Serve as a liaison between healthcare providers and insurance companies, addressing enrollment-related inquiries and facilitating timely resolution
Maintain accurate and up-to-date provider information in databases, and collaborate with internal teams to streamline the enrollment and billing processes

Human Resources Credentialing and Compliance Specialist

The Human Resources Credentialing and Compliance Specialist is responsible for s...

Location

United States , Irving

Salary:

Not provided

CHRISTUS Health

Expiration Date

Until further notice

Requirements

Bachelor’s degree in Management, Business, Human Resources, or a related field is preferred
Excellent verbal and written communication skills
Ability to work independently with minimal direction, leverage all available resources, and effectively solve problems
Must be proficient in Microsoft Office (Excel, Outlook, PowerPoint, and other web-based applications)
Ability to scrub, analyze, and interpret data from multiple sources
2 - 4 years of compliance in HR or Healthcare experience preferred
Customer service experience is preferred
Experience working with a Human Resources Information System (HRIS) preferred
aPHR, PHR, SHRM-CP, or equivalent certification is preferred

Job Responsibility

Uphold and reinforce internal policy standards, guiding as appropriate to reduce risks while ensuring regulatory compliance
Align with internal processes and cascade process expectations to HR partners, leaders, and Associates as we strive to standardize efforts across all ministry locations
Maintain accurate record-keeping within the HRIS, third-party systems, shared folders or drives, and any other location where information is stored or shared
Process project-related data entry in compliance with job requirements and healthcare standards, ensuring a seamless workflow with no gaps
Run ad hoc reports and interpret the data
Draw insights by identifying trends and gaps through data analysis and format the information in a way that is easily digestible by the intended audience
Routinely perform audits on LCR data to ensure integrity, identify opportunities for improvement, clean-up, or correction, and provide recommendations
Assist in the design and implementation of process improvements by working closely with stakeholders to assess, develop, and implement process changes or remediation plans for identified HR-related issues, including, but not limited to, workforce licensing requirements
Routinely troubleshoot and resolve interface and license verification errors
Provide input and participate in projects where LCR is a stakeholder, as necessary, to achieve strategic goals and objectives

Fulltime

Credentialing Auditor

Responsible for auditing all complete credentialing applications and to build so...

Location

United States , Irving

Salary:

Not provided

CHRISTUS Health

Expiration Date

Until further notice

Requirements

Bachelor's Degree preferred
High School or equivalent required
3 years of experience in medical staff and/or managed care credentialing preferred
Certified Provider Credentialing Specialist (CPCS) preferred

Job Responsibility

Coordinate and conduct credentialing audits analyzing provider files for completeness, accuracy, consistency, gaps in work history, relevant references, etc.
Prepare credentialing audit reports tracking and trending auditor findings and assist in the formulation of staff training guides, policies and procedures
Manages multiple concurrent audits, plan audits and related projects ensuring all audit tools comply with NCQA, TJC and CMS requirements
Coordinates the credentialing and re-credentialing process for assigned providers

Fulltime

Provider Credentialing Specialist

Pomelo Care

Location:
United States

Category:
-

Contract Type:
Not provided

Salary:

Job Description:

Job Responsibility:

Requirements:

Additional Information:

Job Posted:
December 11, 2025

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Pomelo Care

Location:United States

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Salary:

Job Description:

Job Responsibility:

Requirements:

Additional Information:

Job Posted:December 11, 2025

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