1,631 Credentialing jobs in the United States

Job Title: Credentialing Specialist

Location: Cherry Hill, NJ (Remote)

Industry: Healthcare Administration

Pay: $24 - $27 / Hour Based on Experience

Benefits: H ealth, Dental, Vision, and 401(k)

About Our Client: Addison Group is partnering with a growing healthcare organization seeking a detail-oriented Credentialing Specialist to support accurate and timely provider enrollment. This is a great opportunity to join a collaborative team and play a key role in supporting insurance and billing operations.

Job Description: The Credentialing Specialist will be responsible for managing the full lifecycle of credentialing and enrollment for healthcare providers across multiple payers. This role ensures compliance and smooth billing by keeping all provider information current and properly documented.

Key Responsibilities:

• Prepare and submit enrollment and re-credentialing applications for insurance payers, including commercial, Medicare, and Medicaid
• Track application statuses and follow up to ensure timely approval
• Collect and manage provider identification numbers and effective start dates
• Maintain credentialing documentation and databases for multiple locations and providers
• Investigate and resolve enrollment-related issues impacting claims
• Keep up with changing credentialing policies across multiple states and payers

Qualifications:

• At least 1 year of experience in healthcare credentialing or payer enrollment
• Familiarity with CAQH and common payer systems is a plus
• Strong organizational and problem-solving skills
• Ability to manage deadlines and maintain attention to detail
• Proficiency in Microsoft Office Suite, especially Excel and Outlook

Additional Details:

• Monday through Friday, 8:00 AM – 4:30 PM
• On-site/hybrid schedule (subject to change based on department needs)

Perks:

• Opportunity to join a reputable organization with long-term growth potential
• Supportive and collaborative team culture
• Weekly pay through Addison Group

Addison Group is an Equal Opportunity Employer. Addison Group provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, gender, sexual orientation, national origin, age, disability, genetic information, marital status, amnesty, or status as a covered veteran in accordance with applicable federal, state and local laws. Addison Group complies with applicable state and local laws governing non-discrimination in employment in every location in which the company has facilities. Reasonable accommodation is available for qualified individuals with disabilities, upon request.

Job Title: Provider Network Consultant

Location: Alb NM or Chicago IL or Oklahoma OK | Remote but training will be onsite

Duration: November 2025 to February 2027 (possible extension)

Pay: $21.00/hr on W2

Positions available: 7

This position is responsible for the analyzing, researching, and applying business rules to complete requests received from providers regarding adds/deletes/changes to their information used for claims processing, membership assignment, and directory purposes. This position is responsible for contracting, credentialing and maintaining Facility / Professional provider data to support marketing, network contracting across all lines of business. This role involves supporting the implementation of special projects, assisting with tracking of various phases of a project and managing workflow. This position includes assisting management in familiarizing and training team members with the various business rules in network contracting and credentialing across all lines of business. In addition is responsible for identifying gaps in processes and suggesting process improvement strategies.

Required Job Qualifications:

* HS Diploma/GED(education verification required) plus 1 year of experience with Provider Network contracting and credentialing systems OR 5 years of experience in the Health Care industry.

* Written and verbal communication skills including interpersonal skills.

* Skills to develop training materials and act as an advisor to staff

* Experience and proficiency inn Microsoft Office software products including analytical tools. Experience developing reports.

Preferred Job Qualifications:

* Bachelor Degree

* Subject Matter Expert for the Professional Provider Credentialing Process

* 2 years of experience with current government sponsored health insurance networks

* Knowledge of health care delivery systems, claim costing analytics, and provider network adequacy analytics

Job Title: Credentialing Specialist

Location: Hackettstown, NJ 07840

Start Date: October 6, 2025

End Date: January 3, 2026

Schedule: Monday–Friday, 8:00 AM – 4:00 PM

Hours per Week: 37.5

Pay: $31/hr

Job Summary:

We are seeking a detail-oriented Credentialing Specialist to support our medical staff credentialing process. This position ensures compliance with regulatory standards and manages the credentialing of physicians and allied health practitioners to maintain accreditation and privileges.

Essential Functions:

• Enforce regulatory compliance and quality assurance related to credentialing
• Prepare and maintain reports of credentialing activities (accreditation, membership, facility privileges)
• Ensure all information meets legal, federal, and state guidelines when processing applications
• Process initial and reappointment applications for approximately 125-200 providers quarterly
• Collect and verify accreditation, licensure, education, training, and experience information
• Maintain and update provider information in the Echo database
• Prepare materials for Credentials Committee, MEC, and Board of Trustees meetings
• Schedule, attend, and take minutes at site-based medical staff meetings as needed
• Process and collect dues for site-based medical staff
• Track license and certification expirations for all providers
• Maintain confidentiality of provider information
• Perform other duties as assigned

Qualifications:

• Knowledge of the credentialing process (required)
• Excellent organizational and prioritization skills with ability to manage multiple tasks
• Strong verbal and written communication skills
• Ability to research and analyze data accurately
• Ability to work independently and establish effective working relationships
• Excellent computer skills

This is a great opportunity for someone with credentialing experience to join a supportive healthcare team in Hackettstown, NJ.

Pride Health offers eligible employee’s comprehensive healthcare coverage (medical, dental, and vision plans), supplemental coverage (accident insurance, critical illness insurance and hospital indemnity), 401(k)-retirement savings, life & disability insurance, an employee assistance program, legal support, auto, home insurance, pet insurance, and employee discounts with preferred vendors

Job Title: Provider Network Consultant

Location: Alb NM or Chicago IL or Oklahoma OK | Remote but training will be onsite

Duration: November 2025 to February 2027 (possible extension)

Pay: $21.00/hr on W2

Positions available: 7

This position is responsible for the analyzing, researching, and applying business rules to complete requests received from providers regarding adds/deletes/changes to their information used for claims processing, membership assignment, and directory purposes. This position is responsible for contracting, credentialing and maintaining Facility / Professional provider data to support marketing, network contracting across all lines of business. This role involves supporting the implementation of special projects, assisting with tracking of various phases of a project and managing workflow. This position includes assisting management in familiarizing and training team members with the various business rules in network contracting and credentialing across all lines of business. In addition is responsible for identifying gaps in processes and suggesting process improvement strategies.

Required Job Qualifications:

* HS Diploma/GED(education verification required) plus 1 year of experience with Provider Network contracting and credentialing systems OR 5 years of experience in the Health Care industry.

* Written and verbal communication skills including interpersonal skills.

* Skills to develop training materials and act as an advisor to staff

* Experience and proficiency inn Microsoft Office software products including analytical tools. Experience developing reports.

Preferred Job Qualifications:

* Bachelor Degree

* Subject Matter Expert for the Professional Provider Credentialing Process

* 2 years of experience with current government sponsored health insurance networks

* Knowledge of health care delivery systems, claim costing analytics, and provider network adequacy analytics

Healthcare Outcomes Performance Company (HOPCo) is a vertically integrated musculoskeletal outcomes management company. HOPCo manages physician practices, hospital service lines, population health and value-based care programs, and musculoskeletal delivery networks.

HOPCo is the managing partner of Arizona-based entities, CORE Institute, Northern Arizona Orthopaedics, CORE Institute Specialty Hospital, Michigan-based CORE Institute, and Florida-based Southeast Orthopedic Specialists Clinics and Musculoskeletal Specialty Hospital.

As HOPCo continues to grow, we are looking for a Credentialing Specialist to join the Credentialing Team. Please see below for the functions and requirements for this position.

Essential Functions

• Reviews and completes hospital and payor applications for all health care providers.
• Completes verification forms/letters for outside facilities.
• Maintain billing insurance grid, provider insurance grid and each individual physician's spreadsheet up to date on current insurance changes.
• Track and maintain physician licensure(s), certification and CME credits.
• Maintain practitioner credentialing files.
• Maintain practitioner electronic file by keeping all applications/licensure current.
• Maintains all renewal applications for both hospitals/insurances.
• Has knowledge of Employee Handbook content along with established policies and procedures.
• Relies on instructions and pre-established guidelines to perform the functions of the job.
• Assists the Credentialing Supervisor in their job responsibilities/duties when necessary.

Education

• High school diploma/GED or equivalent working knowledge preferred.

Experience

• 3-4 years of Credentialing experience.

Requirements

• Must be able to communicate effectively with physicians, providers, licensing agencies, insurance payors and the public and be capable of establishing good working relationships with both internal and external customers.
• Some knowledge of insurance billing and hospital credentialing a plus.

Knowledge

• Knowledge of the credentialing process.
• Knowledge of computer systems.
• Knowledge of credentialing paperwork and timelines.
• Knowledge of credentialing timelines and regulations.

Skills

• Skill in establishing good working relationships with internal and external customers.
• Skill in organizing daily work assignments for various providers.
• Skill in managing multiple work assignments and set priorities.

Abilities

• Ability to establish good working relationships with internal and external customers.
• Ability to communicate effectively with physicians, credentialing agencies and staff.
• Ability to be organized and efficient in daily work activities/projects.

Environmental Working Conditions

• Normal office environment.
• Some travel within community.

Physical/Mental Demands

• Requires sitting and standing associated with a normal office environment.
• Some bending and stretching required.
• Manual dexterity using a calculator and computer keyboard.

#HOP

We are seeking a highly organized and detail-oriented FQHC Insurance Credentialing Specialist to oversee the credentialing and re-credentialing processes for a team of 20+ medical, mental health, and dental providers. This role is responsible for ensuring that all providers meet compliance requirements with federal, state, and commercial insurance regulations, as well as accrediting and licensing bodies. The ideal candidate will have extensive experience in credentialing within a Healthcare or preferably Federally Qualified Health Center (FQHC) setting and the ability to manage the entire credentialing life cycle efficiently.

Essential Functions:

• Manage and oversee the insurance credentialing and re-credentialing process for all providers, including medical, mental health, and dental professionals.
• Maintain up-to-date and accurate insurance credentialing files in accordance with organizational policies and regulatory requirements.
• Ensure timely submission and follow-up on insurance credentialing and payer enrollment applications with Medicare, Medicaid, and commercial insurance providers.
• Monitor provider licenses, DEA registrations, and certifications to ensure compliance with expiration dates and renewal requirements.
• Collaborate with internal departments, including Human Resources, Billing, and Compliance, to streamline provider onboarding and credentialing processes.
• Develop and implement policies and procedures to enhance the efficiency and accuracy of the credentialing process.
• Serve as the primary liaison between the organization and credentialing bodies, insurance networks, and regulatory agencies.
• Conduct periodic audits of provider files and credentialing databases to ensure compliance with internal and external standards.
• Respond to requests for information from insurance companies, licensing agencies, and other credentialing entities.
• Track and report credentialing metrics to leadership, identifying potential delays and providing solutions for process improvements.
• Stay updated on changes in credentialing regulations and payer requirements, ensuring continuous compliance.

Position Requirements:

Education/Experience:

• Degree or certification in healthcare administration, business administration, or a related field preferred. Equivalent work experience may be considered.
• Minimum of 3-5 years of provider credentialing experience, preferably in an healthcare setting.
• Certified Insurance Credentialing Specialist (CICS) or Certified Professional Medical Services Management (CPMSM) preferred but not required.
• In-depth understanding of credentialing, provider enrollment, and regulatory requirements for Healthcare/FQHCs.

Skills/Abilities:

• Strong attention to detail and organizational skills.
• Ability to manage multiple priorities and meet deadlines.
• Excellent written and verbal communication skills.
• Proficiency in credentialing software, electronic health records (EHR), and Microsoft Office Suite.
• Ability to work independently and as part of a team in a fast-paced environment.

Physical Requirements:

While performing the duties of this job, the employee is regularly required to sit; use hands to manipulate objects, tools or controls; reach with hands and arms; and talk and hear. The employee must be able to occasional lift and/or move up to 15 pounds. Specific vision abilities required by this job include close vision, distance vision, peripheral vision, depth perception and the ability to adjust focus. Noise level in the work environment is usually quiet.

Overview:

Presbyterian is seeking a highly detail-oriented Credentialing Specialist to conduct comprehensive background investigations on physicians and healthcare providers seeking affiliation with our Albuquerque and regional facilities.

• This is a Full Time (1.0 FTE) position - Exempt: No
• Job is based at Presbyterian Hospital
• Work hours: Days

Join our team and play a crucial role in maintaining the integrity and excellence of our medical staff.

• High School Diploma
• One (1) to three (3) years experience in hospital medical staff or managed care credentialing preferred.
• Certification or eligibility for certification as a Current certification as a Certified Professional Medical Services Management (CPMSM) or Certified Provider Credentialing Specialist (CPCS) preferred.

• Analyze practitioner applications and/or requests to ensure that required documentation/information has been submitted in order to initiate the primary source verification processes
• Conducts primary source verification of applicants' education, licensure, professional work history, medical malpractice history for the purpose of determining competency and eligibility to be awarded membership and/or privileges
• Prepares processed files for review by appropriate members of medical staff leadership, including identification of information that may require additional investigation
• Utilizes appropriate tracking tools for the purpose of ensuring timely completion of applications
• Collects/analyzes data from various sources to include with initial and/or reappointment applications. Such data includes but is not limited to focused professional practice evaluations, ongoing professional practice evaluations, and privileging eligibility criteria
• Process other credentialing requests, as assigned, in accordance with established policies and procedures
• Responsible for on-boarding and/or orientation of new Medical Staff members, according to established policies and procedures

About Presbyterian Healthcare Services

Presbyterian offers a comprehensive benefits package to eligible employees, including medical, dental, vision, disability coverage, life insurance, and optional voluntary benefits.

The Employee Wellness Rewards Program encourages staff to engage in health-enhancing activitieslike challenges, webinars, and screeningswith opportunities to earn gift cards and other incentives.

As a mission-driven organization, Presbyterian is deeply committed to improving community health across New Mexico through initiatives like growers' markets and local partnerships.

Founded in 1908, Presbyterian is a locally owned, not-for-profit healthcare system with nine hospitals, a statewide health plan, and a growing multi-specialty medical group. With nearly 14,000 employees, it is the largest private employer in the state, serving over 580,000 health plan members through Medicare Advantage, Medicaid, and Commercial plans.

AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke free campuses.