Credentialing Specialist
Position Overview
The Credentialing Assistant / Specialist supports the credentialing and onboarding process for healthcare providers across Ultra Health Providers. This role assists with the collection, verification, and submission of credentialing documentation required for provider enrollment with Medicare, Medicaid, commercial insurance carriers, and Accountable Care Organizations (ACOs).
The role also partners with Human Resources by managing the collection and organization of provider documentation required during onboarding that supports credentialing and payer enrollment processes.
The position plays a key role in ensuring timely onboarding, credentialing, and payer enrollment for Nurse Practitioners, Licensed Clinical Social Workers (LCSWs), and other clinical providers so they can deliver services and bill appropriately.
Key Responsibilities
Provider Onboarding & Documentation (HR Partnership)
Coordinate credentialing documentation during provider onboarding in collaboration with Human Resources.
Collect and verify required provider documents including:
- State licenses
- DEA registrations
- Board certifications
- Malpractice insurance
- NPI registration
- Education and training records
- Professional CV and employment history
- Medicare
- Medicaid
- Commercial insurance payers
- Accountable Care Organizations (ACOs)
- Maintain provider credentialing database and documentation repository.
- Monitor license expirations and credential renewal timelines.
- Ensure credentialing records remain compliant with payer and regulatory requirements.
- Maintain credentialing status trackers and enrollment reporting.
- Provide administrative support to the Practice Manager related to credentialing.
- Maintain credentialing trackers and enrollment status reports.
- Communicate credentialing progress to operations, HR, and leadership teams.
- Assist with onboarding coordination related to credentialing documentation requirements.
- Ensure credentialing processes align with payer guidelines and regulatory requirements.
- Maintain confidentiality of provider documentation and sensitive information.
- Assist with credentialing audits when required.
- Support internal compliance documentation related to provider credentialing.
- Associate’s or Bachelor’s degree preferred
- Equivalent healthcare administrative experience considered
- Experience in provider credentialing, payer enrollment, or healthcare onboarding processes
- Familiarity with CAQH, Medicare, and Medicaid enrollment processes
- Strong document management and attention to detail
- Ability to manage multiple credentialing applications simultaneously
- Proficiency in Microsoft Office and credentialing databases
- Ability to coordinate with HR and operational teams
- CPCS – Certified Provider Credentialing Specialist
- CPMSM – Certified Professional Medical Services Management
- Attention to detail
- Organization and follow-through
- Regulatory awareness
- Communication with payers and providers
- Ability to manage timelines and documentation
- Cross-functional coordination with HR and operations