We are seeking a detail-oriented Medical Credentialing Specialist to support the credentialing and recredentialing process for healthcare providers. This role is responsible for ensuring providers meet all regulatory, accreditation, and payer requirements so they can deliver services and receive reimbursement. .

Key Responsibilities:

Manage the initial credentialing and recredentialing process for physicians, nurses, and allied health professionals. Verify provider qualifications, including licenses, certifications, education, work history, malpractice coverage, and references. Prepare and submit credentialing applications to hospitals, health plans, and insurance networks. Maintain accurate provider records and ensure all documentation is current and compliant. Track application status and follow up with payers, licensing boards, and other agencies as needed. Monitor expiration dates for licenses, DEA registrations, board certifications, and insurance documents. Ensure compliance with internal policies, payer standards, NCQA, CMS, and other regulatory guidelines. Serve as a point of contact for providers and internal departments regarding credentialing status and requirements. Assist with audits and reporting related to provider enrollment and credentialing files. .