CREDENTIALING SPECIALIST

Credentialing Specialist performs credentialing, privileging, and payor enrollment for providers, including processing applications, verifying licenses (licensure, DEA), board certifications, professional liability, and other documents; maintains CAQH profiles and NPPES registrations; ensures accuracy and completeness, identifies discrepancies, and conducts follow-up; manages recredentialing and payor enrollment per regulatory standards (NCQA, HRSA/FTCA, Joint Commission, CMS, AAAHC) and other standards; supports provider data management within credentialing systems; collaborates with internal and external parties to maintain provider files.