Credentialing Specialist - United States
2 days ago

Job description
Column Technical Service is seeking a detail‑oriented, compliance‑focused Credentialing Specialist with hands‑on experience in URAC, NCQA, and payer enrollment processes. In this role, you will ensure accurate provider onboarding, regulatory compliance, and timely participation in government and commercial health plans. You will play a key role in supporting accreditation standards, maintaining provider data integrity, and managing the full lifecycle of credentialing and enrollment activities. Apply today to learn more about this exciting opportunity and make a meaningful impact on day one.
Key Responsibilities
Credentialing & Recredentialing
- Coordinate and process provider credentialing and recredentialing applications in alignment with URAC and NCQA standards.
- Maintain complete, accurate, and up‑to‑date credentialing files and supporting documentation.
- Conduct primary source verification (PSV), including licensure, sanctions, education, board certification, and NPDB queries.
- Perform ongoing monitoring of provider credentials.
- Serve as the primary point of contact for providers throughout the credentialing process, ensuring timely communication regarding outstanding tasks, follow‑ups, and inquiries.
- Maintain accurate provider data within credentialing systems and enrollment tracking tools; perform routine data integrity audits.
Payer Enrollment
- Prepare, submit, and track payer enrollment applications for government and commercial health plans.
- Assist providers with maintaining accurate and updated profiles in CAQH, PECOS, and NPPES.
- Support accreditation audits by ensuring documentation accuracy and compliance.
Qualifications
- 2+ years of strong Credentialing knowledge and experience in provider credentialing and payer enrollment.
- Solid understanding of URAC, NCQA, and state regulatory requirements.
- Experience with CAQH, PECOS, state Medicaid systems, and payer portals.
- Effective communication skills for collaborating with providers and external stakeholders.
- Customer service mindset with a focus on supporting healthcare professionals.
- Highly organized with strong attention to detail and the ability to meet deadlines.
- Experience in the healthcare or behavioral health industry is a plus.
- Bachelor's degree in healthcare administration, business, or a related field preferred.
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