Sample Job Description for Credentialing Specialist

Find below a sample job description template for the position of Credentialing Specialist:

Job Title: Credentialing Specialist

Location of the Job: Sacramento, CA 95825

Years of Experience: 2 to 3 Years

Job Type: Full Time Employee

Education Level: Bachelor’s degree

Job Summary:

The Network Management Credentialing Specialist is responsible for performing credentialing activities in support of network recruitment activities.​

Duties and Responsibilities:

  • Maintains required logs and prepare reports, as needed.
  • Produce provider correspondence as necessary to process the applications.
  • Answer inquiries regarding provider credentialing status.
  • Maintains knowledge of CMS and NCQA credentialing guidelines.
  • Perform monthly internal audits on credentialing and re-credentialing files for accuracy and compliance with Credentialing Policies and Procedures
  • Provide credentialing staff mentoring.
  • Keep Manager informed of concerns or problems with credentialing processes.
  • Assists market in any pre-delegation audits and the annual on providers delegated for the credentialing process.
  • Prepare presentations for credentialing committee meetings including meeting agendas and minutes.
  • Summarize provider information for peer review by the Credentialing committee.
  • Identify and analyze non-routine provider records.
  • Confirm all required verifications are complete and have been performed according to required standards and within required timeframes.
  • Accurate data entry of credentialing information into the database.
  • Other duties as assigned.

Position Requirements:

  • Opportunity for growth
  • Excellent work environment
  • Competitive salary and benefit package
  • Excellent communication skills
  • 2+ years of related experience

Salary: $15.00 – $20.00 Hourly DOE