Credentialing Specialist

Position Summary

Summary of Responsibilities

• Manage credentialing and enrollment data by entering, updating, and maintaining accurate provider information in systems and databases, including CAQH, PECOS, NPPES, and MMIS.
• Coordinate provider credentialing and re-credentialing activities, ensuring applications and supporting documentation are complete, accurate, and submitted timely.
• Monitor licenses and credentials, including state licenses, DEA registrations, and board certifications, and proactively track expiration dates to support timely renewals.
• Review provider files for completeness, accuracy, and compliance with JCCA policies, accreditation standards, and applicable regulatory requirements.
• Identify and resolve discrepancies and potential barriers that could delay credentialing or enrollment, escalating issues to the Human Resources Business Partner and Managed Care Supervisor when appropriate.
• Partner with clinical providers and supervisors/managers to obtain required information and documentation and provide timely responses to credentialing questions.
• Work collaboratively with JCCA’s external credentialing vendor to facilitate efficient processing and timely onboarding of clinical practitioners.
• Maintain accurate records and ensure credentialing information is consistently documented and up to date.
• Protect confidential provider information and exercise sound judgment and discretion in all credentialing-related communications.
• Perform other related duties as assigned.

Qualifications

• Bachelor’s degree and at least two years of related experience preferred. Equivalent combinations of education, training, and experience will be considered.
• Knowledge of healthcare provider credentialing, enrollment, and accreditation principles, processes, documentation, and requirements.
• Strong attention to detail and the ability to manage multiple priorities, deadlines, and provider files simultaneously.
• Excellent verbal and written communication and strong interpersonal skills.
• Ability to analyze information, identify discrepancies, troubleshoot issues, and exercise independent judgment.
• Ability to work independently while maintaining strong communication and collaboration with the HR and clinical teams.
• Strong organizational skills and a high level of accuracy.
• Ability to maintain confidentiality and discretion when handling sensitive provider information.
• Working knowledge of Microsoft Word and Excel.
• Ability to learn and effectively use new systems, databases, and applications.

Pay Rate