We're hiring a Provider Credentialing Specialist to join our team - remotely! This full-time role will support provider credentialing, recredentialing, hospital privileging, payer enrollment, state licensure, and onboarding across our organization. If you're detail-oriented, organized, and experienced in healthcare credentialing, we'd love to hear from you. Apply today and grow with Radiology Imaging Associates. Position Summary The Provider Credentialing Specialist is responsible for coordinating and maintaining the credentialing, recredentialing, privileging, and payer enrollment activities for physicians, advanced practice providers, and other applicable healthcare professionals. This position ensures that provider credentials are accurate, complete, current, and compliant with organizational policies, payer requirements, hospital medical staff bylaws, and applicable federal and state regulations. The Credentialing Specialist works closely with providers, practice leadership, hospital medical staff offices, payers, licensing boards, and internal teams to facilitate timely provider onboarding and prevent delays in scheduling, clinical privileges, payer participation, and reimbursement. Essential Duties and Responsibilities Provider Credentialing and Recredentialing Coordinate the initial credentialing and recredentialing of physicians, advanced practice providers, and other healthcare professionals. Collect, review, and verify provider documentation, including: Medical education and postgraduate training Residency and fellowship history Professional licenses Board certifications DEA registrations Controlled substance registrations Professional liability insurance Work history Hospital affiliations Professional references Continuing education documentation Immunizations and health screenings, when required Conduct primary source verification in accordance with organizational, payer, hospital, and accreditation requirements. Review credentialing files for completeness, accuracy, inconsistencies, unexplained gaps, expiration dates, and potential adverse information. Obtain explanations and supporting documentation for professional liability claims, disciplinary actions, sanctions, work-history gaps, or other credentialing exceptions. Prepare complete credentialing files for internal review, credentialing committee review, or submission to external entities. Monitor recredentialing cycles and initiate the recredentialing process within established timeframes. State Licensure Coordinate and manage the initial application, renewal, and maintenance of professional state licenses for physicians, advanced practice providers, and other applicable healthcare professionals. Prepare and submit applications to state medical and professional licensing boards, including applications through the Interstate Medical Licensure Compact, when applicable. Gather and submit required supporting documentation, including education and training verifications, examination history, work history, malpractice claims information, background checks, fingerprints, references, and explanations of disciplinary or adverse actions. Communicate with providers, state licensing boards, educational institutions, training programs, and other third parties to obtain outstanding documentation and resolve application deficiencies. Track license applications from submission through approval, maintain documentation of all follow-up activities, and provide regular status updates to providers and organizational leadership. Monitor license expiration dates and continuing education requirements to ensure renewals are completed before expiration. Assist providers with securing additional state licenses based on organizational growth, telemedicine coverage, client requirements, and provider scheduling needs. Promptly escalate licensing delays, restrictions, disciplinary actions, or other concerns that could affect a provider's ability to practice or begin employment. Maintain accurate, current copies of state licenses and related information in the organization's credentialing and provider data systems. Hospital and Facility Privileging Prepare and submit initial appointment, reappointment, and clinical privilege applications to hospitals and other healthcare facilities. Coordinate requests for temporary privileges, additional privileges, change-of-status applications, and facility-specific documentation. Communicate with hospital medical staff offices regarding application status, missing information, committee dates, effective dates, and outstanding requirements. Maintain current records of provider appointments, privileges, facility affiliations, and reappointment dates. Assist providers with completing hospital-specific privilege forms, case logs, competency documentation, and delineation-of-privilege requirements. Escalate potential delays that could affect a provider's start date, clinical schedule, or ability to perform services. Payer Enrollment/Revalidations Complete and submit initial enrollment, revalidation, demographic update, reassignment, and termination applications for commercial payers and government programs, working with third party vendors when necessary. Track payer applications from initial submission through approval and effective date. Follow up with payers regularly and respond promptly to requests for additional documentation or clarification. Verify participation status, network effective dates, provider identifiers, group affiliations, reassignment arrangements, and service locations. Coordinate with billing and revenue cycle teams to ensure provider enrollment information is accurately reflected in billing systems. Identify and resolve enrollment issues that may result in claim denials, payment delays, out-of-network processing, or loss of revenue. Maintain documentation of application submissions, reference numbers, follow-up activities, approvals, and effective dates. Manage quarterly provider directory compliance updates Compliance and Ongoing Monitoring Monitor provider credentials and ensure timely renewal of licenses, certifications, DEA registrations, liability insurance, and other required documents. Perform or coordinate ongoing monitoring of applicable federal and state exclusion, sanction, disciplinary, and licensure databases. Immediately escalate identified exclusions, sanctions, adverse actions, expired credentials, or other compliance concerns in accordance with organizational policy. Support compliance with applicable credentialing standards, delegation agreements, payer requirements, hospital medical staff bylaws, and organizational policies. Maintain credentialing files in an audit-ready condition. Assist with payer, hospital, client, delegated credentialing, and internal compliance audits. Protect confidential provider information and maintain records in accordance with privacy, security, and record-retention requirements. Data Management and Reporting Enter and maintain accurate provider information in the organization's credentialing, payer enrollment, practice management, and related systems. Maintain provider rosters, credentialing trackers, enrollment reports, expiration reports, and status dashboards. Perform routine audits to identify incomplete, inconsistent, duplicated, or outdated provider data. Prepare reports regarding credentialing status, payer enrollment, hospital privileges, upcoming expirations, provider start dates, and outstanding items. Ensure provider demographic information is consistent across systems, including: Legal and professional names National Provider Identifier, or NPI Taxonomy codes Practice locations Billing and pay-to addresses Group affiliations Tax identification numbers Medicare and Medicaid identifiers Payer participation information Participate in credentialing system implementations, upgrades, data clean-up initiatives, and process-improvement projects. Provider Onboarding and Communication Communicate credentialing and enrollment requirements to new providers in a clear and timely manner. Serve as a primary point of contact for providers regarding credentialing, payer enrollment, and hospital privileging. Provide regular status updates to providers, practice leadership, operations, scheduling, revenue cycle, and other stakeholders. Coordinate credentialing activities with recruitment, contracting, human resources, compliance, IT, scheduling, and billing teams. Identify barriers that may delay provider onboarding and escalate them to the appropriate leader. Deliver professional and courteous customer service when communicating with providers, hospitals, payers, clients, and external agencies. Additional Responsibilities Maintain current knowledge of credentialing, payer enrollment, and provider data requirements. Develop and maintain credentialing procedures, checklists, templates, and reference materials. Assist with training new credentialing team members. Recommend workflow improvements that increase accuracy, accountability, efficiency, and visibility. Participate in department meetings and special projects. Perform other duties as assigned. Minimum Qualifications High school diploma or equivalent required. Associate degree in healthcare administration, business administration, health information management, or a related field preferred. At least two years of experience in provider credentialing, payer enrollment, medical staff services, healthcare administration, or a related field preferred. Experience credentialing physicians and advanced practice providers. Working knowledge of provider credentialing, recredentialing, payer enrollment, and hospital privileging processes. Experience using CAQH and payer enrollment portals. Proficiency with Microsoft Outlook, Word, and Excel. Ability to manage multiple providers, applications, deadlines, and follow-up activities simultaneously. Strong written and verbal communication skills. Strong attention to detail and ability to identify discrepancies in provider documentation. Ability to handle confidential and sensitive information appropriately. Preferred Qualifications Experience supporting a large physician group or hospital system. Experience credentialing providers across multiple hospitals, facilities, states, or payer networks. Experience with PECOS, Medicaid enrollment systems, NPPES, CAQH, and commercial payer portals. Familiarity with Medicare reassignments, group enrollment, practice-location updates, and provider revalidation. Experience with credentialing or provider data management software. Familiarity with delegated credentialing requirements and credentialing audits. Knowledge of accreditation and industry credentialing standards. Certified Provider Credentialing Specialist, or CPCS, certification preferred but not required. Certified Professional Medical Services Management, or CPMSM, certification is a plus. Experience working with radiology or other hospital-based specialties is a plus. Knowledge, Skills, and Abilities The successful candidate should demonstrate: Exceptional attention to detail and accuracy Strong organization and time-management skills Effective application tracking and follow-up Ability to prioritize work based on provider start dates, expirations, revenue impact, and compliance risk Ability to work independently while collaborating effectively with a team Strong problem-solving and research skills Professional communication with physicians, executives, payers, hospital personnel, and external agencies Ability to interpret payer requirements and application instructions Ability to recognize and escalate potential compliance concerns Ability to maintain composure and professionalism when handling urgent or overdue matters Intermediate proficiency in spreadsheets, reporting, and electronic document management Performance Expectations Performance may be evaluated based on: Timeliness of initial credentialing and recredentialing Accuracy and completeness of credentialing files Timely submission of payer and hospital applications Frequency and documentation of application follow-up Timely renewal of expiring credentials Accuracy of provider data across credentialing and billing systems Number of applications returned for missing or inaccurate information Provider onboarding turnaround time Prevention and resolution of enrollment-related claim denials Responsiveness to providers and internal stakeholders Audit readiness and compliance with credentialing policies Physical and Work Requirements Prolonged periods of sitting and working at a computer. Frequent use of standard office equipment. Ability to communicate by telephone, email, video conference, and in person. Ability to manage electronic records and, when applicable, physical credentialing files. Ability to work additional hours during periods of high volume, audits, system implementations, or urgent provider onboarding. Confidentiality and Compliance The Provider Credentialing Specialist is expected to maintain the confidentiality and security of provider, patient, organizational, and business information. The employee must comply with all applicable organizational policies, contractual requirements, privacy and security standards, and federal and state regulations.