Relief Mental Health
Position Summary
The
Credentialing Specialist
is responsible for ensuring that all healthcare providers maintain active status by successfully managing the initial and ongoing credentialing and re-credentialing processes with commercial and government payers across multiple states. This role plays a critical part in ensuring provider compliance, network participation, and timely reimbursement by managing all credentialing documentation, applications, and payer communications. Essential Duties & Responsibilities Manage the end-to-end credentialing and re-credentialing process for individual providers and provider groups across multiple states and payers (commercial, Medicare, TRICARE, etc.). Initiate and complete credentialing applications, ensuring accuracy and timely submission to health plans and regulatory bodies. Set up and maintain provider records in online enrollment systems, payer portals, and internal credentialing databases. Monitor and manage provider enrollment status, ensuring credentialing deadlines, expirations, and revalidations are met. Maintain up-to-date and compliant provider files, including licenses, board certifications, CAQH profiles, malpractice insurance, collaborative agreements, and controlled substance registrations. Perform regular updates to provider CAQH profiles in accordance with CMS-recommended timelines. Apply for and renew all required state and federal licenses and registrations prior to expiration. Respond to payer and provider inquiries professionally and promptly. Conduct primary source verification and background checks to validate eligibility and compliance with standards. Track and oversee Collaborative Agreements between Nurse Practitioners and Physicians. Manage and negotiate provider fee schedules, seeking optimal reimbursement rates from payers. Complete revalidation and credentialing applications as required by commercial and government payers. Maintain provider status tracking systems to ensure data integrity and credentialing readiness. Monitor and ensure compliance with NCQA, State, Federal, and payer-specific credentialing standards and regulations. Collaborate with leadership to ensure timely onboarding and removal of providers based on employment status. Maintain confidentiality and adhere to HIPAA, legal, and ethical standards in all credentialing activities. Required Education & Experience Bachelor's degree in Healthcare Administration, Business Administration, or a related field; OR a minimum of 5 years of relevant experience in credentialing. 3+ years of experience in medical staff or provider credentialing within a hospital or physician practice setting. Hands-on experience with credentialing applications for state licensing boards, federal programs, and commercial health plans. Strong familiarity with the CAQH ProView database and the provider application process. Working knowledge of credentialing procedures, payer enrollment standards, and regulatory compliance. Proficient in MS Office Suite, credentialing software, and touch-typing. Excellent verbal and written communication skills. Preferred Education & Experience NAMSS certification: Certified Provider Credentialing Specialist (CPCS) or Certified Professional Medical Services Management (CPMSM). Deep understanding of NCQA standards, CMS regulations, and other credentialing accreditation requirements. Experience with managing and maintaining Collaborative Agreements for Nurse Practitioners and Physicians. Knowledge, Skills, & Abilities Exceptional attention to detail and commitment to accuracy and completeness in all credentialing work. Highly organized, with the ability to manage multiple priorities and tight deadlines. Strong critical thinking and problem-solving skills to resolve credentialing challenges. Self-motivated and proactive; able to work independently and take initiative. Strong interpersonal skills and a collaborative, team-oriented mindset. Ability to communicate professionally and respectfully with peers, providers, vendors, and leadership. Commitment to ethical conduct, confidentiality, and compliance with all organizational and regulatory guidelines. Maintains a high level of professionalism, discretion, and integrity in all work interactions.
The
Credentialing Specialist
is responsible for ensuring that all healthcare providers maintain active status by successfully managing the initial and ongoing credentialing and re-credentialing processes with commercial and government payers across multiple states. This role plays a critical part in ensuring provider compliance, network participation, and timely reimbursement by managing all credentialing documentation, applications, and payer communications. Essential Duties & Responsibilities Manage the end-to-end credentialing and re-credentialing process for individual providers and provider groups across multiple states and payers (commercial, Medicare, TRICARE, etc.). Initiate and complete credentialing applications, ensuring accuracy and timely submission to health plans and regulatory bodies. Set up and maintain provider records in online enrollment systems, payer portals, and internal credentialing databases. Monitor and manage provider enrollment status, ensuring credentialing deadlines, expirations, and revalidations are met. Maintain up-to-date and compliant provider files, including licenses, board certifications, CAQH profiles, malpractice insurance, collaborative agreements, and controlled substance registrations. Perform regular updates to provider CAQH profiles in accordance with CMS-recommended timelines. Apply for and renew all required state and federal licenses and registrations prior to expiration. Respond to payer and provider inquiries professionally and promptly. Conduct primary source verification and background checks to validate eligibility and compliance with standards. Track and oversee Collaborative Agreements between Nurse Practitioners and Physicians. Manage and negotiate provider fee schedules, seeking optimal reimbursement rates from payers. Complete revalidation and credentialing applications as required by commercial and government payers. Maintain provider status tracking systems to ensure data integrity and credentialing readiness. Monitor and ensure compliance with NCQA, State, Federal, and payer-specific credentialing standards and regulations. Collaborate with leadership to ensure timely onboarding and removal of providers based on employment status. Maintain confidentiality and adhere to HIPAA, legal, and ethical standards in all credentialing activities. Required Education & Experience Bachelor's degree in Healthcare Administration, Business Administration, or a related field; OR a minimum of 5 years of relevant experience in credentialing. 3+ years of experience in medical staff or provider credentialing within a hospital or physician practice setting. Hands-on experience with credentialing applications for state licensing boards, federal programs, and commercial health plans. Strong familiarity with the CAQH ProView database and the provider application process. Working knowledge of credentialing procedures, payer enrollment standards, and regulatory compliance. Proficient in MS Office Suite, credentialing software, and touch-typing. Excellent verbal and written communication skills. Preferred Education & Experience NAMSS certification: Certified Provider Credentialing Specialist (CPCS) or Certified Professional Medical Services Management (CPMSM). Deep understanding of NCQA standards, CMS regulations, and other credentialing accreditation requirements. Experience with managing and maintaining Collaborative Agreements for Nurse Practitioners and Physicians. Knowledge, Skills, & Abilities Exceptional attention to detail and commitment to accuracy and completeness in all credentialing work. Highly organized, with the ability to manage multiple priorities and tight deadlines. Strong critical thinking and problem-solving skills to resolve credentialing challenges. Self-motivated and proactive; able to work independently and take initiative. Strong interpersonal skills and a collaborative, team-oriented mindset. Ability to communicate professionally and respectfully with peers, providers, vendors, and leadership. Commitment to ethical conduct, confidentiality, and compliance with all organizational and regulatory guidelines. Maintains a high level of professionalism, discretion, and integrity in all work interactions.