Credentialing Specialist I

Job Summary:

Health Choice Network is seeking a Credentialing Specialist I to support credentialing and recredentialing activities for healthcare providers across the organization. This role is responsible for ensuring compliance with regulatory, accreditation, and health plan requirements through accurate provider data management, timely primary source verification, and effective communication with centers and stakeholders. The ideal candidate is detail-oriented, highly organized, and committed to maintaining the integrity and accuracy of provider credentialing records.

Key Responsibilities:

• Process initial credentialing applications and reappointment files, ensuring accuracy, completeness, and timely submission.
• Perform primary source verification activities in accordance with regulatory, accreditation, and payer requirements.
• Monitor provider licenses, certifications, registrations, and other required credentials to ensure timely renewals and compliance.
• Collect, verify, maintain, and update provider information within credentialing databases and internal systems.
• Identify discrepancies, incomplete documentation, or potential compliance concerns and escalate issues as appropriate.
• Prepare credentialing files and supporting documentation for leadership review and credentialing committee meetings.
• Maintain accurate records and documentation in accordance with organizational policies and regulatory standards.
• Communicate credentialing, recredentialing, and provider enrollment status updates to centers and stakeholders.
• Generate reports and track credentialing activities to support operational and compliance requirements.
• Safeguard confidential provider information and ensure compliance with privacy and security standards.
• Support organizational priorities and perform additional duties as assigned.

Qualifications:

• Associate degree preferred, or an equivalent combination of education and experience.
• Minimum of one (1) year of experience in a healthcare-related role preferred.
• Basic understanding of provider credentialing, regulatory requirements, and healthcare compliance standards.
• Experience working with credentialing software, databases, and internal tracking systems.
• Proficiency with Microsoft Office applications, including Excel, Word, and Outlook.
• Strong attention to detail and commitment to data accuracy and integrity.
• Ability to maintain confidentiality when handling sensitive provider information.
• Effective written and verbal communication skills.
• Strong organizational and time management skills with the ability to manage multiple priorities and deadlines.
• Ability to work independently and collaboratively within a team environment.

Preferred Qualifications:

• Previous experience in provider credentialing, medical staff services, provider enrollment, or healthcare administration.
• Experience working within a healthcare organization, Federally Qualified Health Center (FQHC), or managed care environment.
• Familiarity with credentialing and enrollment requirements for commercial, Medicare, and Medicaid health plans.
• Knowledge of regulatory and accreditation standards related to provider credentialing.
• Experience maintaining provider data within credentialing databases and verification systems.

What We Offer:

• 100% Remote Work – Work from anywhere in the U.S.
• 100% Employer-Paid Medical Insurance
• Annual $1,500 HSA Contribution
• Generous Paid Time Off (PTO)
• 403(b) Retirement Plan with Employer Contribution
• Professional Development & Education Assistance
• Mission-Driven Culture Focused on Community Health