Credentialing Specialist

Overview
We are seeking a detail-oriented and proactive Credentialing Specialist to join our healthcare administration team. In this vital role, you will be responsible for managing the multi-state credentialing process for healthcare providers, ensuring compliance with industry standards, and maintaining accurate provider records. Your expertise will help facilitate smooth provider onboarding, credential verification, and ongoing compliance, ultimately supporting the delivery of high-quality patient care. This position offers an exciting opportunity to contribute to a dynamic healthcare environment where precision and efficiency are paramount.

Credentialing Specialist (Multi-State) Job Description

Hopkins Medical Association

Join a growing, multi-state healthcare organization where your expertise directly supports provider success and patient access to quality care.

Hopkins Medical Association (HMA) is seeking a highly organized and detail-oriented Credentialing Specialist to manage provider credentialing and enrollment across multiple states. This role is essential to ensuring regulatory compliance, timely payer enrollment, and seamless onboarding of providers across our expanding network.

What You’ll Do

• Manage full-cycle provider credentialing, re-credentialing, and payer enrollment across multiple states
• Prepare, submit, and track applications with commercial payers, Medicare, Medicaid, and facilities
• Maintain accurate and compliant provider records in accordance with CMS, NCQA, and state-specific requirements and ensuring all documentation meets managed care organization (MCO) policies and regulatory standards
• Monitor and track expiration dates for licenses, DEA registrations, board certifications, and insurance documents
• Serve as the primary liaison between providers, payers, and internal departments regarding credentialing status
• Complete CAQH enrollments, attestations, and ongoing maintenance
• Support new provider onboarding, including multi-state expansion and telehealth credentialing
• Ensure timely follow-up on applications, denials, and revalidations to prevent revenue disruption
• Assist with audits and ensure readiness for regulatory or payer reviews
• Collaborate with billing, compliance, and operations teams to gather necessary documentation such as licenses, certifications, malpractice insurance, and continuing education records to streamline credentialing workflows
• Maintain comprehensive and up-to-date provider files,
• Communicate effectively with providers, insurance companies, and internal teams to resolve credentialing issues promptly

What We’re Looking For

• Proven experience in medical office administration or healthcare credentialing roles
• Strong understanding of managed care processes and NCQA standards
• Excellent knowledge of medical terminology and healthcare documentation requirements
• Demonstrated ability to manage multiple tasks efficiently while maintaining attention to detail
• Effective communication skills to liaise with providers, insurance carriers, and internal stakeholders
• Familiarity with electronic health records (EHR) systems or credentialing software is preferred
• Ability to work independently in a fast-paced environment while adhering to strict deadlines
• Strong knowledge of payer enrollment processes, CAQH, PECOS, and credentialing timelines
• Familiarity with Medicare, Medicaid (multi-state), and commercial payer requirements
• Exceptional attention to detail and ability to manage high-volume, complex documentation
• Strong organizational and time management skills with the ability to prioritize competing deadlines

Preferred Qualifications

• Minimum 3 years of credentialing experience, preferably in a multi-state or multi-specialty environment
• CPCS (Certified Provider Credentialing Specialist) certification
• Experience with credentialing software platforms (e.g., CredentialMyDoc or similar systems)
• Knowledge of telehealth and multi-state licensing requirements

Why Join Hopkins Medical Association

• Be part of a rapidly growing, multi-state healthcare organization
• Collaborative, mission-driven team focused on expanding patient access to care
• Opportunity to build and improve scalable credentialing processes
• Competitive compensation based on experience
• Professional growth and advancement opportunities

Abilities Required

• Advanced proficiency in Microsoft Office (Word, Excel, Outlook) and computer skills
• Strong data entry accuracy and documentation management skills
• Ability to manage multiple providers and applications simultaneously
• Understanding of complex regulatory standards including CMS, NCQA, and state requirements
• Excellent time management and ability to meet strict deadlines
• Demonstrated ability to work independently while contributing to a team environment
• Flexibility and adaptability in a growing, evolving organization
• Must have good problem-solving skills
• Must be able to accept direction and adhere to policies and procedures.
• Excellent verbal and written communication skills.
• Reports to work at the start of shift ready to perform assigned duties, abides by attendance policy to include regular staff meeting attendance.
• Organizes work to complete duties effectively and efficiently.
• Maintain confidentiality of patient information and adhere to HIPAA regulations

PHYSICAL DEMANDS: Primarily works inside. Light physical work, sitting, writing, walking, bending, climbing, lifting and carrying items weighing up to 40 pounds. Must possess physical condition adequate for performance of the work. Must possess physical conditioning adequate for the performance of the work. Reasonable accommodations will be made to persons with disabilities upon request.

EQUIPMENT USED

1. Computer and various software programs

2. Printer, copy and facsimile

3. Telephone

The statements herein are intended to describe the general nature and level of work being performed by employees and are not to be construed as an exhaustive list of responsibilities, duties, and skills required. Furthermore, they do not establish a contract for employment and are subject to change at the discretion of the employer.

Pay: $19.00 - $23.00 per hour

Benefits:

• Dental insurance
• Health insurance
• Paid time off
• Retirement plan
• Vision insurance

Work Location: In person

Salary : $19 - $23