Cerner Credentialing Specialist

Credentialing Specialist

The ideal candidate will serve as a subject matter expert capable of bridging the gap between vendor technology and clinical operations. They must possess a strong understanding of the product’s functionality and troubleshooting techniques, enabling them to validate system performance and identify issues. This includes evaluating current workflows, recognizing opportunities for optimization, and recommending improvements in either system design or operational processes. The candidate should have firsthand industry experience in Credentialing solutions and demonstrate deep familiarity with the application of electronic health records in that setting. They must work to resolve issues and change requests. They must be able to confidently lead discussions with diverse stakeholders, assess current-state workflows, and propose enhancements that consider both immediate needs and downstream impacts. Additionally, they should be adept at articulating changes to affected groups, integrating those insights into training content and communication strategies to support long-term success across future rollouts.

Applicants with VA and/or DoD experience are preferred, along with an active federal clearance or the ability to obtain one

Type of Employment: Full-time salaried and fully benefited position

Work Location/Travel: Washington, DC

Expected 50% travel required; applicants must be free from travel restrictions to accommodate evolving needs of the client.

Salary Range: $52,123 – 57,456 base salary, depending on experience and location. Competitive salary/pay, potential for bonuses. There are multiple factors that are considered in determining final pay for a position, including, but not limited to, relevant work experience, skills, certifications and competencies that align to the specified role, geographic location, education and certifications as well as contract provisions regarding labor categories that are specific to the position. The pay range for this position is highly competitive but dependent upon employment type (1099, contract, W2).

Role Reports to: Clinical Capability Lead

Direct Reports: This role has no direct reports.

Responsibilities:

• Manage end-to-end credentialing process including enrollment, initial credentialing, and re‑credentialing.

• Conduct primary source verification of credentials (licenses, DEA, board certifications, education, work history).

• Maintain accurate provider data in credentialing systems (e.g., CAQH, CredentialStream, PECOS, NPPES).

• Track expiration of licenses, credentials, malpractice insurance, CME, and renewals; manage recredentialing timelines.

• Submit credentialing/enrollment applications to payers and follow up until in‑network status confirmed.

• Ensure compliance with state/federal regulations, NCQA, TJC, CMS, and accrediting institutions.

• Assist in developing/improving internal credentialing policies and procedures.

• Respond to information requests from regulatory agencies or public inquiries as required.

Knowledge and Skills Required:

• Deep knowledge of healthcare regulatory requirements, credentialing standards (NCQA, TJC, CMS), and payer credentialing rules.

• Strong attention to detail and analytical skills to review applications, detect discrepancies, and resolve credentialing issues.

• Exceptional organizational and time-management skills, able to manage high volumes independently.

• Excellent written and verbal communication skills.

• Research-savvy, able to verify documentation across diverse systems and sources.

• Flexible and adaptable to frequent travel, with no restrictions on mobility.

Education/Certification Required:

• Bachelor’s degreein Health Information Management, Healthcare Administration, Business Administration, or a related field required.

Preferred - Education/Certification:

• CPCS (Certified Provider Credentialing Specialist) certification from NAMSS is highly preferred.

Experience Required:

• 3 years in healthcare credentialing or provider enrollment (specialist or coordinator roles).

• VA and/or DoD credentialing experience is strongly preferred.

• Experience ensuring compliance with regulatory standards and interacting with payers or government entities.

• Proven ability to manage credentialing data and documentation systems effectively.

• Demonstrated expertise in streamlining credentialing processes with accelerated turnaround times, enabling candidates to onboard and begin work more quickly.

• Technical Skills Required

Technical Skills:

• Proficiency in MS Office suite; advanced Excel preferred.

• Familiarity with credentialing platforms: CAQH ProView, CredentialStream, PECOS, NPPES, NPDB queries.

• Experience using healthcare compliance databases and understanding of data entry best practices.

All applicants must be US citizens and able to obtain a Public Trust clearance. Edera participates in the E-Verify program. Edera is a drug-free workplace.

Edera is an Equal Opportunity and Affirmative Action Employer. Edera prohibits discrimination against individuals based on their race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other category protected by law. Edera takes affirmative action to employ and advance in employment individuals without regard to race, color, religion, sex, sexual orientation, gender identify, national origin, disability, or veteran status.