Credentialing Specialist

Credentialing Specialist

Locations: LVPI / SVSC / IMB (Las Vegas – Jones, Blue Diamond, Henderson, Nellis) 

Position Overview

We are seeking a detail-oriented Credentialing Specialist to manage provider credentialing and enrollment across multiple clinical locations. This role is responsible for ensuring all providers meet regulatory, licensing, and payer requirements, while maintaining accurate and up-to-date records.

Compensation & Employment Terms

Initial 3-month evaluation (trial) period

Opportunity for long-term employment and growth based on performance and reliability

Key Responsibilities

1. Provider Credentialing & Enrollment

Manage initial credentialing and re-credentialing for providers

Prepare and submit applications to insurance payers (Medicare, Medicaid, commercial plans)

Track application status and follow up with payers as needed

2. Licensing & Compliance

Monitor and maintain active provider licenses, certifications, and registrations

Ensure compliance with federal, state, and payer requirements

Maintain credentialing files in accordance with regulatory standards

3. Documentation & Record Management

Maintain accurate and organized provider records and databases

Update CAQH profiles and other credentialing platforms

Ensure timely renewals and documentation updates

4. Communication & Coordination

Serve as a liaison between providers, payers, and internal staff

Respond to credentialing-related inquiries in a timely manner

Coordinate with administrative and billing teams to ensure provider enrollment accuracy

5. Audits & Quality Assurance

Prepare for internal and external credentialing audits

Identify and resolve discrepancies or compliance issues

Support continuous improvement of credentialing processes

Qualifications

Experience in medical credentialing or healthcare administration preferred

Familiarity with CAQH, Medicare, Medicaid, and commercial payer enrollment

Strong attention to detail and organizational skills

Ability to manage multiple providers and deadlines

Excellent communication and follow-up skills

Core Competencies

Attention to Detail & Accuracy

Regulatory Compliance

Time Management & Organization

Communication & Coordination

Problem-Solving