390 Credentialing Specialist jobs in the United States

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

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.

A Credentialing Specialist contributes to AHFs mission by thoroughly inspecting the backgrounds of all providers that treat and interact with our members. At the start of every day, our goal is to provide quality healthcare by presenting the most valued healthcare professionals, as quality healthcare is the pulse of our service to the community. The Credentialing Specialist works closely with the Human Resources and Provider Relations departments to credential all providers and facilities.

The responsibilities of a Credentialing Specialist are very labor-intensive. There is significant attention-to-detail in management of the credentialing process, entering accurate data across all systems and platforms and most importantly, fact-checking all education, reports and verifications.

The Credentialing Specialist adds consistent value to the Managed Care Team and AHF members by continually offering peace-of-mind that our service providers are verified and trustworthy.

We at AIDS Healthcare Foundation believe that each individual is entitled to equal employment opportunities without regard to race, color, creed, gender, sexual orientation, gender identity, marital status, national origin, age, veteran status or disability. The right of equal employment opportunity extends to recruiting, hiring selection, transfer, promotion, training and all other conditions of employment. AHF will consider qualified applicants with criminal histories in a manner consistent with the requirements of the ordinance.

One of Insight Global's revenue cycle clients are looking for a Credentialing Specialist to join their team in Cherry Hill, NJ. This individual will be responsible for submitting initial and re-credentialing enrollment applicants for payor HMO, Medicare, and Medicaid. They will also follow up and check the status of submitted applications with payors, track and follow up to obtain provider ID numbers and effective dates, and serve as a liaison between billing department and the payors on troubleshooting claims denials due to provider enrollment issues.

The ideal candidate is comfortable working onsite in Cherry Hill, NJ 2 days/week. The schedule is 8AM-4:30PM.

We are a company committed to creating diverse and inclusive environments where people can bring their full, authentic selves to work every day. We are an equal opportunity/affirmative action employer that believes everyone matters. Qualified candidates will receive consideration for employment regardless of their race, color, ethnicity, religion, sex (including pregnancy), sexual orientation, gender identity and expression, marital status, national origin, ancestry, genetic factors, age, disability, protected veteran status, military or uniformed service member status, or any other status or characteristic protected by applicable laws, regulations, and ordinances. If you need assistance and/or a reasonable accommodation due to a disability during the application or recruiting process, please send a request to com.

To learn more about how we collect, keep, and process your private information, please review Insight Global's Workforce Privacy Policy: .

- EPIC Experience
- High School Diploma or GED

- 3+ years of enrollment experience

- Strong computer software skills (Excel, word, etc.)

- Excellent written/verbal communication

Participates in and performs the credentialing and re-credentialing processes for providers to ensure credentialing/re-credentialing and projects are completed in a timely manner. Meets the standards as set forth in the Credentialing Policies and Procedures and NCQA compliance. Carries out all duties while maintaining compliance and confidentiality and promoting the mission and philosophy of the organization.

Essential Functions:

• Gathers, researches, compiles and documents physician data used in the credentialing process.
• Investigates discrepancies, reports and documents findings.
• Maintains databases/records of required provider information, including but not limited to licensures and documents.
• Performs new provider credentialing activities including preparation of new provider files to be presented to the Board or Credentialing Committee per NCQA Standards.
• Ensures new Providers have hospital membership at all appropriate hospitals within the allotted time frame.
• Ensures new provider applications (Medicare/Medicaid/Tricare/TCMS/TMA, etc.) are submitted timely and follows through to completion.
• Performs the re-credentialing process to ensure all providers are re-credentialed within the re-credentialing renewal cycle. Assists in preparing reports of any discrepancies to the Board or Credentialing Committee.
• Ensures hospital privilege applications are sent to the appropriate facilities in a timely manner and addresses additional requests relating to such as necessary.
• Ensures credentialing files are kept current and orderly.
• Monitors/tracks Medicare and Medicaid enrollment process. Addresses necessary issues regularly.
• Monitors licensure/insurance expiration date activity for both internal and external providers.
• Monitors all required regulatory websites as required by NCQA Standards. Documents findings. Reports any issues identified to Supervisor.
• Adheres to all company policies, including but not limited to, OSHA, HIPAA, compliance and Code of Conduct.
• Regular and dependable attendance.
• Follows the core competencies set forth by the Company, which are available for review on CMSweb.

Other Duties and Responsibilities:

• Provides regular workload/productivity reports to supervisor.
• Responds professionally and effectively to questions from external sources, i.e., customer or carrier, and internal sources, i.e., provider or management team.
• Attends required in-services, training sessions, and department meetings.
• Performs other duties as assigned.

Qualifications:

Education and Experience:

Required: High school diploma or GED. One (1) or more years of clerical experience.

Preferred: Experience working in credentialing and/or medical office. Experience using credentialing software.

Knowledge, Skills and Abilities:

• Excellent computer and keyboarding skills, including familiarity with Windows.
• Excellent verbal and written communication skills.
• Excellent attention to detail.
• Excellent customer service skills.
• Excellent interpersonal & problem solving skills.
• Ability to work in a team environment as well as independently.
• Ability to engage others, listen and adapt response to meet others' needs.
• Ability to align own actions with those of other team members committed to common goals.
• Ability to organize and prioritize own work schedule.
• Ability to manage competing priorities.
• Ability to perform job duties in a professional manner at all times.
• Ability to understand, recall, and communicate, factual information.
• Ability to understand, recall, and apply oral and/or written instructions or other information.
• Ability to organize thoughts and ideas into understandable terminology.
• Ability to apply common sense in performing job.

Certificate/License: None

Work Schedule: Monday to Friday 8am to 5pm