What are the responsibilities and job description for the Credentialing Specialist position at Insync Consulting Services LLC?
InSync Consulting Services is seeking a detail-oriented Credentialing Specialist to support the onboarding and ongoing compliance of dental providers within a multi-state network. This role is responsible for managing both initial credentialing and re-credentialing processes while ensuring all provider data meets regulatory and organizational standards.
The position handles an average of 12–16 new provider credentialing files per month, along with ongoing re-credentialing cycles (every three years). The ideal candidate is highly organized, tech-savvy, and experienced in working with credentialing platforms and regulatory databases.
Key Responsibilities
- Coordinate and manage initial credentialing and re-credentialing for network providers
- Gather, verify, and maintain provider documentation in compliance with credentialing standards
- Utilize platforms such as CAQH and the National Practitioner Data Bank (NPDB) to verify provider information, including licensure and sanction history
- Maintain accurate provider records and ensure all files meet audit and regulatory requirements
- Conduct outreach to providers to obtain required documentation and resolve discrepancies
- Prepare completed credentialing files for final review and executive approval
- Set up newly credentialed providers in internal systems
- Manage provider contracts and fee schedules
- Maintain and update provider directories (Commercial and Medicare)
- Upload updated provider data to health plans and regulatory entities on a monthly basis
- Run reports related to provider adequacy, accessibility, and sanction monitoring
- Support compliance by preparing data for monthly sanction meetings
- Process provider updates, terminations, and member communications
- Serve as a point of contact for provider offices regarding credentialing status and verification requests
- Coordinate with external network partners and leased network organizations
Qualifications
Required:
- Minimum 1 year of credentialing experience (medical or provider credentialing accepted)
- Strong technical skills, including experience with credentialing systems and Microsoft Excel
- High School Diploma or GED
- Strong attention to detail, organization, and ability to manage multiple priorities
Preferred:
- Experience in the insurance or healthcare industry
- Familiarity with credentialing platforms such as CAQH and NPDB
- Knowledge of provider enrollment, compliance, and regulatory requirements
Pay: $24.27 - $26.00 per hour
Work Location: In person
Salary : $24 - $26