Credentialing Specialist

We are looking for a Credentialing Specialist to support a Contract assignment in Quincy, Massachusetts. In this role, you will oversee provider credentialing and recredentialing activities, ensuring records are accurate, complete, and aligned with payer and regulatory standards. The position will focus primarily on master’s-level therapists and nurse practitioners while partnering with internal teams to maintain timely provider enrollment documentation.

Responsibilities:

• Manage end-to-end credentialing and recredentialing workflows for providers, with emphasis on master’s-level therapists and nurse practitioners.
• Examine submitted applications and supporting documents to confirm completeness, accuracy, and compliance with organizational and payer requirements.
• Validate qualifications such as active licensure, certifications, education, clinical training, employment background, malpractice coverage, and board status.
• Maintain provider files and update records when changes occur, including licensure renewals, credential revisions, and employment information updates.
• Communicate with providers, payers, and internal stakeholders to resolve missing information and keep credentialing timelines on track.
• Track due dates and renewal schedules to help prevent lapses in credentialing or participation status.
• Use electronic medical record systems and related databases to document, monitor, and organize credentialing information.
• Support related administrative processes connected to provider data accuracy and downstream revenue cycle needs when required.
• Prior experience in provider credentialing, recredentialing, or a closely related healthcare administrative function.
• Working knowledge of verifying licenses, certifications, education, training history, malpractice coverage, and other provider qualifications.
• Familiarity with electronic medical record systems and comfort navigating healthcare documentation platforms.
• Understanding of medical billing, medical coding, claims processing, collections, or related revenue cycle concepts.
• Experience using EPACES or similar payer eligibility and provider information tools is preferred.
• Strong attention to detail with the ability to review documentation thoroughly and identify discrepancies quickly.
• Effective written and verbal communication skills for coordinating with providers, payers, and internal teams.