Credentialing Specialist

Credentialing Specialist Job Description The Credentialing Specialist is responsible for ensuring the completeness, accuracy, and compliance of credentialing applications. This role involves conducting primary source verification, validating documentation, and maintaining credentialing files. The analyst will collaborate with internal teams and external partners to provide credentialing-related information, support audit readiness, and contribute to financial reporting accuracy. Responsibilities Review initial and reappointment credentialing applications for completeness, accuracy, and regulatory compliance. Conduct primary source verification and validate documentation to meet credentialing standards. Identify and resolve discrepancies, gaps, or issues that may impact provider enrollment, escalating concerns when necessary. Monitor and maintain credentialing files to ensure compliance with internal quality standards and external accreditation requirements. Submit provider rosters to delegated health plans, ensuring accuracy and timely follow-up. Update provider data in the credentialing database, ensuring precision and consistency across financial and operational records. Prepare and track verification requests to support high-volume application processing. Collaborate with internal teams and external partners to resolve pending action items in the EHR system. Support audit readiness and contribute to financial reporting accuracy through credentialing documentation. Perform additional duties as assigned to support the accounting and finance team. Essential Skills Experience in credentialing, data entry, and using CAQH, PECOS, and EPREP platforms. Familiarity with credentialing software such as MDStaff and IntelliSoft. Strong healthcare, customer service, and medical terminology knowledge. High School Diploma or GED required. 5+ years of experience in healthcare provider credentialing and recredentialing across all payer types. Proficient with CAQH and Medicare's PECOS database. Extensive experience using EMR/EHR systems. Strong proficiency in Microsoft Office Suite, with the ability to analyze and interpret data effectively. Additional Skills & Qualifications Certified Provider Credentialing Specialist (CPCS) certification preferred, or actively pursuing certification. Demonstrated ability to thrive in fast-paced, evolving environments and adapt to ambiguity with innovative problem-solving. Work Environment The position is on-site in Bethesda, MD, five days a week with a start time of 8:00 AM or 9:00 AM. The company offers an employee-centered culture that supports diversity and inclusion, and a management style that encourages and empowers personal and professional growth.