What are the responsibilities and job description for the Credentialing Specialist position at EMERALD IV THERAPY LLC?
About Us
At American Medical Group we’re committed to excellence in patient care, provider support, and healthcare compliance. As a recognized leader in the healthcare industry, we strive to maintain the highest standards of quality and integrity. We’re currently seeking a Medical Staff Credentialing Specialist to join our growing team and play a key role in ensuring our providers are properly credentialed and in full compliance with regulatory and organizational standards.
Position Summary
The Medical Staff Credentialing Specialist is responsible for managing all aspects of the credentialing and recredentialing processes for healthcare providers. This includes verifying credentials, maintaining accurate records, communicating with internal teams and external agencies, and ensuring compliance with federal, state, and organizational guidelines.
Key Responsibilities
Collect, review, and verify provider credentials (licenses, certifications, education, malpractice insurance, etc.)
Maintain and update credentialing information with current provider information
Submit and track credentialing and recredentialing applications with health plans and regulatory bodies
Monitor expiration dates and ensure timely renewals of all required credentials
Communicate with providers, payers, and internal departments to resolve credentialing issues
Ensure compliance with NCQA, URAC, CMS, and other regulatory and accreditation standards
Prepare and support audits and reporting requests as needed
Maintain confidentiality of provider information and organizational data
Qualifications
High school diploma or equivalent required; Associate’s or Bachelor’s degree preferred
2 years of experience in credentialing, provider enrollment, or healthcare administration
Knowledge of medical terminology and healthcare compliance standards
Proficiency with credentialing software and databases (e.g. CAQH, PECOS, NPPES)
Strong attention to detail, organizational skills, and ability to meet deadlines
Excellent communication and interpersonal skills
Ability to work independently and in a team environment
Preferred Qualifications
Certification from NAMSS (e.g. CPCS or CPMSM) is a plus
Experience with managed care organizations, hospitals, or large medical groups
Familiarity with Medicare, Medicaid, and commercial insurance plans