Description
The Credentialing Specialist processes practitioner and organization/facility provider applications for credentialing and recredentialing in accordance with state and federal regulations, NCQA accreditation standards, and other payer requirements. The role handles primary-source documentation, verifies information, updates systems, categorizes cases, reports findings, resolves file-disposition inquiries, provides credentialing-status information to internal and external stakeholders, and may attend credentials committee meetings and participate in audits. An associate degree is preferred, while two to five years of relevant experience and knowledge of credentialing standards, CAQH, Microsoft Office, and customer communication are required.
