JOB DESCRIPTION
Position: Credentialing Specialist
Reports to: Director of Credentialing
Effective Date: 08/04/2026
Position Summary
The Credentialing Specialist is responsible for credentialing, recredentialing, and ongoing monitoring activities for participating healthcare practitioners while ensuring compliance with NCQA standards, regulatory requirements, and organizational policies. The Credentialing Specialist will provide insights and support to all practice members, employees, and stakeholders. As the Credentialing Specialist, you will report to the Credentialing Manager.
The job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee. Duties, responsibilities and activities may change, or new ones may be assigned at any time with or without notice.
Qualifications
- ·2+ years of credentialing work experience in a managed care organization, insurance plan, hospital. or physician practice environment (preferred).
- ·Intermediate Microsoft Excel experience required.
- ·High School diploma required; some college or experience in equivalent field (preferred).
- ·Strong analytical, organizational, and computer skills required.
Core Competencies
- ·Communication: Strong written and verbal communication and interpersonal skills to effectively engage with internal staff and clients to maintain a positive rapport. Able to manage conflict successfully.
- ·Problem-solving: Demonstrated ability to research issue and bring about resolution either directly or with the assistance of others.
- ·Productivity: Ability to meet established deadlines and productivity expectations with minimal supervision. .
- ·Technical Knowledge: Knowledge and skills in computer operations including proficiency in Microsoft applications. Ability to perform basic analytical functions and basic statistical concepts.
- ·Confidentiality: Understanding of privacy and security re: PHI, HIPAA, HITECH and/or HITRUST.
Duties and Responsibilities
- Maintain credentialing and recredentialing files
- Perform primary source verification activities
- Develops an understanding of the entire credentialing life cycle process.
- Researches and responds to internal and external department inquiries.
- Assists with maintenance of an accurate database of all client information.
- Tracks timeliness of data loads, to include date submitted, date confirmation received, error rate and corrections needed. Reports non-compliance for further direction.
- Contact clients to follow up on enrollment status.
- Retains communication with clients for reference purposes.
- Maintain accurate credentialing databases
- Conduct ongoing monitoring of providers for sanctions, exclusions, licensure, board certification, Medicare/Medicaid eligibility, and other reportable actions.
- Assists with delegated credentialing activities and ensures compliance with applicable NCQA and payer requirements
- Attends Credentialing Committee meetings as a support representative
- Additional duties and responsibilities as assigned.
Physical Demands
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Sedentary, sitting, walking, occassional liftine (overhead, waist level) from floor, bending, frequent near vision use for reading and computer use and driving.
Work Environment
This position is a home-based position with some travel required for client meetings and interactions as well as for work-based meetings. The home-work environment should be a professional and quiet setting with no distractions that would interfere with focus to complete work tasks. All work-related equipment will be provided.
Job Type: Full-time
Pay: $40,000.00 - $44,000.00 per year
Benefits:
- AD&D insurance
- Dental insurance
- Disability insurance
- Flexible schedule
- Health insurance
- Life insurance
- Paid time off
- Retirement plan
- Vision insurance
Application Question(s):
- Do you live in or near Kentucky?
Experience:
- Delegated Credentialing: 1 year (Required)
Work Location: Hybrid remote in Louisville, KY 40243
