The primary goal of this position is to manage the complex administrative and compliance-driven processes required for healthcare professionals to practice and for the organization to receive payment.
Provider Credentialing (Verification and Compliance)
Credentialing is the process of verifying a healthcare provider's qualifications to ensure they meet professional and regulatory standards. It's the quality control step.
experience
5 ...
The primary goal of this position is to manage the complex administrative and compliance-driven processes required for healthcare professionals to practice and for the organization to receive payment.
Provider Credentialing (Verification and Compliance)
Credentialing is the process of verifying a healthcare provider's qualifications to ensure they meet professional and regulatory standards. It's the quality control step.
<p>The Credentialing Specialist is responsible for coordinating, processing, and tracking healthcare provider licenses (MDs, DOs, NPs, RNs, etc.) across multiple U.S. states, including through licensure compacts (IMLC/NLC). This role ensures timely, accurate, and compliant onboarding and re-credentialing of providers in accordance with regulatory and organizational standards<br /><br />Key Responsibilities:<br /><br />1. State Licensing Coordination<br /><br />Prepare and submit new license applications, renewals, and updates with state medical/nursing boards.<br /><br />Monitor license expiration dates and proactively manage renewals to avoid lapses.<br /><br />Liaise with state boards to resolve delays or discrepancies in applications.<br /><br />Maintain thorough knowledge of state-specific requirements, timelines, and fees.<br /><br />2. Licensure Compact Programs (IMLC/NLC)<br /><br />Process multistate licenses under Interstate Medical Licensure Compact (IMLC) or Nurse Licensure Compact (NLC) rules.<br /><br />Keep up to date with changes in compact states, eligibility criteria, and documentation needs.<br /><br />3. Credentialing Support<br /><br />Complete primary source verification (PSV) for licenses, education, DEA, board certification, OIG/SAM exclusions, etc.<br /><br />Work closely with credentialing analysts to ensure data accuracy in credentialing databases (e.g., Cactus, Modio, symplr, Citrix etc..).<br /><br />4. Data Management & Reporting<br /><br />Maintain detailed, audit-ready records of licensing activities.<br /><br />Generate regular reports on licensing status, pending applications, and expirations.<br /><br />Update internal systems and provider directories with current licensure information.<br /><br />5. Stakeholder Communication<br /><br />Act as a point of contact for providers regarding licensing requirements, timelines, and documentation.<br /><br />Collaborate with credentialing, compliance, and provider relations teams if required<br /><br />6. Audit & Compliance<br /><br />Support internal and external audits (e.g., NCQA, URAC, Joint Commission).<br /><br />Ensure adherence to CMS, state, and accrediting body standards.<br /><br />Required Skills and Qualifications:<br /><br />Bachelor’s degree or equivalent experience in healthcare administration or a related field.<br /><br />2–5 years of experience in credentialing, licensing, or provider enrollment.<br /><br />Knowledge of state licensure processes for MDs, DOs, NPs, and RNs.<br /><br />Familiarity with IMLC, NLC, and digital application portals (e.g., FCVS, BREEZE).<br /><br />Strong organizational skills with attention to detail and deadlines.<br /><br />Proficiency in credentialing software (e.g., Cactus, Verity, Modio, symplr).<br /><br />Excellent communication and follow-up skills.<br /><br />Preferred Qualifications:<br /><br />NAMSS certification (CPCS or CPMSM) a plus.<br /><br />Experience in multi-state or telehealth provider licensing.</p><h3>experience</h3>6
