CREDENTIALING SPECIALIST Job at Creative Financial Staffing, Pittsburgh, PA

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  • Creative Financial Staffing
  • Pittsburgh, PA

Job Description

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.

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