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CREDENTIALING SPECIALIST
Pittsburgh, PA
$50,000- $60,000

Are you detail-oriented, organized, and passionate about maintaining high standards in healthcare compliance? We are seeking a Credentialing Specialist to join our client's team and ensure all providers meet the regulatory and organizational standards required to deliver quality care.

• Be part of a mission-driven team committed to delivering quality care.

• Opportunities for professional growth and advancement.

• Competitive benefits, PTO, and work-life balance.

OVERVIEW OF THE CREDENTIALING SPECIALIST ROLE:

• Manage the full credentialing and re-credentialing process for healthcare providers (physicians, NPs, PAs, etc.).

• Collect, review, and verify all required documentation, licenses, certifications, and background checks.

• Submit and track applications to insurance plans, hospitals, and other regulatory bodies.

• Maintain and update credentialing databases and provider files with current information.

• Monitor expiration dates and proactively initiate the renewal process for licensure and credentials.

• Communicate regularly with providers, payers, and internal departments to ensure compliance and timely processing.

• Assist in audits and ensure compliance with NCQA, CMS, and other regulatory requirements.

PREFERRED QUALIFICATIONS FOR THE CREDENTIALING SPECIALIST:

• 2+ years of experience in credentialing or provider enrollment within a healthcare setting.

• Strong understanding of state and federal credentialing guidelines.

• Proficient in credentialing software (e.g., CAQH, Availity, or similar platforms).

• High attention to detail and excellent organizational skills.