Credentialing and Licensing Specialist

Job description

Accountabilities: Manage provider credentialing, recredentialing, licensing, payer enrollment, and renewal activities from application through completion. Review, validate, and maintain documentation including professional licenses, certifications, education, training, malpractice coverage, work history, sanctions, exclusions, and other required provider information. Research and resolve non-routine credentialing, licensing, payer enrollment, and provider data discrepancies, escalating complex regulatory or compliance matters when appropriate. Monitor expiration dates, application progress, outstanding documentation, and renewal deadlines to ensure timely provider participation and continued compliance. Maintain accurate and complete provider records and credentialing databases while safeguarding data integrity. Communicate directly with healthcare providers, licensing boards, payers, credentialing committees, regulatory agencies, and internal stakeholders to clarify requirements, provide status updates, and resolve issues. Support audits, accreditation reviews, compliance reporting, and credentialing committee activities by gathering documentation, validating records, and responding to information requests. Identify documentation or process gaps and contribute to improvements that increase credentialing accuracy, efficiency, and timeliness. Provide informal training, guidance, and quality-review support to less experienced credentialing team members on systems, procedures, and documentation standards. Manage multiple priorities and deadlines while maintaining a high level of attention to detail and follow-through. Requirements: High school diploma or equivalent required; an associate degree is preferred. 3–5 years of experience in healthcare credentialing, provider licensing, provider enrollment, healthcare administration, or a related field. In-depth knowledge of provider credentialing, recredentialing, licensing, payer enrollment, and provider data management processes. Working knowledge of applicable regulatory, accreditation, payer, and organizational credentialing requirements. Familiarity with NCQA, CMS, state licensing requirements, or comparable healthcare standards is preferred. Experience with credentialing platforms, provider databases, payer portals, HRIS systems, or other provider data management technologies is advantageous. Strong ability to research and resolve non-routine issues while interpreting established procedures and requirements. Exceptional attention to detail, organization, follow-through, and documentation accuracy. Ability to manage multiple deadlines and competing priorities in a structured, compliance-focused environment. Strong written and verbal communication skills, with the ability to interact professionally with providers, payers, agencies, and internal stakeholders. Ability to work independently while collaborating effectively across teams. CPMSM, CPCS, or equivalent credentialing certification is preferred but not required. Benefits: Anticipated base compensation range of $22.99–$34.49 per hour. Actual compensation may vary based on experience, skills, qualifications, geographic location, internal equity, and business needs. Remote work opportunity within the United States. Full-time employment in a healthcare-focused environment. Opportunity to work across provider credentialing, licensing, enrollment, regulatory compliance, and healthcare operations. Exposure to audits, accreditation activities, payer requirements, and cross-functional healthcare stakeholders. Opportunities to provide guidance and quality support to other credentialing professionals. Equal employment opportunity and reasonable accommodation support for qualified applicants. How Jobgether works: We use an AI-powered matching process to ensure your application is reviewed quickly, objectively, and fairly against the role's core requirements. Our system identifies the top-fitting candidates, and this shortlist is then shared directly with the hiring company. The final decision and next steps (interviews, assessments) are managed by their internal team. We appreciate your interest and wish you the best! Why Apply Through Jobgether? Data Privacy Notice: By submitting your application, you acknowledge that Jobgether will process your personal data to evaluate your candidacy and share relevant information with the hiring employer. This processing is based on legitimate interest and pre-contractual measures under applicable data protection laws (including GDPR). You may exercise your rights (access, rectification, erasure, objection) at any time. #LI-CL1 This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for a Credentialing and Licensing Specialist based in United States. This role is responsible for ensuring healthcare providers remain properly credentialed, licensed, enrolled, and compliant with applicable requirements.You will manage complex provider documentation and data while keeping records accurate, complete, and audit-ready.The position combines detailed administrative work with problem-solving across providers, payers, licensing boards, regulatory agencies, and internal teams.You will play an important role in preventing credentialing delays and maintaining uninterrupted provider participation.The environment is collaborative and deadline-driven, with opportunities to contribute to audits, accreditation activities, and process quality.As a senior-level specialist, you will also provide guidance and informal support to less experienced credentialing professionals.This is a strong opportunity for an experienced healthcare credentialing professional seeking a remote role with meaningful operational and compliance impact.