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Licensing & Credentialing Specialist

Peregrine Health
Nashville, USA
Full-time
Mid
Onsite
Discovered 1 weeks ago

Full Job Posting

Key Responsibilities

  • Provider Information Intake: Collect and maintain personal, contact, and professional information for each provider, including NPI, CAQH credentials, Medicare and Medicaid numbers, employment history with dates, education history, and documented explanations for any gaps.
  • State Licensure Applications: Prepare and submit initial license and endorsement applications to state boards for nurse practitioners, clinical social workers, and professional counselors, and track each application through issuance.
  • Board Correspondence: Respond to state board requests, deficiency notices, and verification requirements, and resolve outstanding items without waiting for a follow-up from the board.
  • Licensure Support Requirements: Coordinate the supporting steps each state requires, including primary source verifications, supervision records for endorsement, fingerprinting and background checks, jurisprudence exams, and continuing education documentation.
  • License Renewals: Track renewal deadlines and continuing education requirements for every provider and every active state license, and complete renewals before expiration.
  • Multi-State Licensure: Maintain working knowledge of licensure requirements, timelines, and compact eligibility for each state Peregrine operates in, and apply the correct requirements to each provider.
  • Credentialing Document Collection: Obtain the complete required document set from each provider, including government-issued ID, Social Security card, professional diploma, official transcripts, resume, state licenses for all active states, board certification, DEA and controlled substance registration where applicable, BLS card, immunization records, malpractice insurance and certificate of insurance, claims history, and W-9.
  • File Completeness Review: Verify each credentialing file against the requirements for that provider type, state, and receiving organization before submission, and identify missing, expired, or inconsistent items.
  • Submission and Tracking: Submit complete packets to the appropriate receiving party, confirm receipt, track each submission through to approval, and follow up on anything that stalls.
  • Provider Follow-Up: Drive outstanding documentation and application requests to completion with providers directly, escalating when a missing item puts a start date at risk.
  • CAQH and Profile Maintenance: Keep provider CAQH profiles and related credentialing profiles current, complete, and attested on schedule.
  • Expirables Management: Track expiration dates for licenses, board certifications, DEA and CSR registrations, BLS cards, malpractice coverage, and immunizations, and collect renewals before they lapse.
  • Recordkeeping: Maintain organized, accurate, audit-ready provider files and keep licensing and credentialing status current in Peregrine's systems.
  • Status Reporting: Report licensing and credentialing status by provider and site, and flag risks to start dates early enough to act on them.
  • Sensitive Information Handling: Handle Social Security numbers, dates of birth, and other sensitive provider information in accordance with Peregrine's privacy and security policies.
  • Process Documentation: Keep checklists, templates, state requirement references, and submission instructions current as requirements change.

Qualifications

  • Required
  • Two or more years of provider credentialing, licensing, or medical staff services experience.
  • Experience assembling complete credentialing files and submitting them to health systems, payers, credentialing verification organizations, or delegated credentialing partners.
  • Working knowledge of standard credentialing documentation, including state licenses, board certification, DEA and controlled substance registration, NPI, CAQH, malpractice coverage, and immunization requirements.
  • Demonstrated follow-through on outstanding items, including persistent direct follow-up with busy clinicians.
  • Strong attention to detail and the discipline to catch an incomplete or expired document before it is submitted.
  • Ability to track many open files at once with accurate status on each.
  • Clear, professional written and verbal communication with providers, partner organizations, and internal teams.
  • Experience handling sensitive personal information appropriately and in compliance with privacy requirements.
  • Preferred
  • Experience credentialing behavioral health providers, advanced practice providers, or licensed clinical social workers and counselors.
  • Multi-state credentialing or licensing experience.
  • Experience with CAQH ProView, NPPES, PECOS, and state licensing board portals.
  • Experience in an FQHC, rural health, community health, or multi-site care delivery setting.
  • Familiarity with delegated credentialing arrangements and NCQA credentialing standards.
  • Experience building or improving credentialing trackers, checklists, or reporting.
  • Certified Provider Credentialing Specialist (CPCS) or equivalent certification.

Benefits

  • Competitive salary.
  • Full medical, dental, and vision coverage.
  • 20 days of paid time off plus nine paid holidays.
  • 401(k) with employer match.
  • $1,800 annually toward mental healthcare.
  • $5,000 fertility-care benefit.
  • Bonus eligibility.

Preferred Qualifications

  • Preferred

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