Credentialing Specialist - PFS

The Patient Financial Services Credentialing Specialist at Maui Health System, part of the Kaiser Foundation Hospitals, is responsible for managing the full scope of provider credentialing, recredentialing, and payer enrollment functions. This position plays a vital role in supporting timely and compliant provider onboarding, which directly impacts access to care, billing readiness, and quality outcomes. The specialist ensures that all credentialing activities are conducted in accordance with Kaiser Permanente policies, state and federal regulations, and accrediting agency standards (e.g., NCQA, CMS). Working closely with medical staff, revenue cycle, compliance, and provider onboarding teams, this position contributes to the integrity of Maui Health Systems high-performance network.

• Credentialing & Enrollment Management
• Coordinate the end-to-end process of initial credentialing, recredentialing, and payer enrollment for physicians, advanced practice providers, and allied health professionals across all Maui Health facilities.
• Submit and monitor applications for Medicare, Medicaid (Hawaii QUEST Integration), and commercial health plans, ensuring compliance with payer-specific timelines and requirements.
• Maintain provider profiles and documents in internal systems (e.g., credentialing software, EHR) and national databases (CAQH, NPPES, PECOS).
• Documentation & Compliance Oversight
• Ensure accurate and complete documentation of licenses, DEA certifications, board certifications, malpractice coverage, and background checks.
• Prepare and maintain audit-ready digital files in compliance with internal policies, The Joint Commission, and NCQA standards.
• Support internal and external credentialing audits and respond to payer inquiries related to enrollment.
• Cross-Functional Coordination
• Serve as the credentialing liaison to provider onboarding, medical staff services, and revenue cycle departments.
• Collaborate with clinical leaders and human resources to align credentialing timelines with start dates and clinical scheduling.
• Track and communicate credentialing progress and issues to stakeholders, escalating when necessary to ensure timely resolution.
• Reporting & Continuous Improvement
• Develop and maintain dashboards and credentialing status reports for leadership.
• Identify inefficiencies and recommend improvements to credentialing workflows and systems.
• Ensure timely renewal of expiring credentials and recredentialing to prevent delays in billing and patient access.
• Provider Relations & Support
• Educate new and existing providers on the credentialing process, documentation requirements, and payer expectations.
• Provide high-quality customer service to internal stakeholders and external payer representatives.
• Support initiatives that align credentialing efforts with Kaiser Permanentes values of excellence, integrity, and patient-centered care.

Qualifications:

• Minimum of two (2) years experience in provider credentialing or payer enrollment in a hospital, health plan, or medical group setting.

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• Proficiency with CAQH, PECOS, NPPES, and payer enrollment portals.
• Familiarity with CMS regulations, Hawaii-specific Medicaid (e.g., AlohaCare, HMSA QUEST), and commercial payer requirements.
• Strong attention to detail, time management, and written/verbal communication skills.

• Experience with credentialing software (e.g., MD-Staff, Modio, Credential Stream).
• Associates or Bachelors degree in healthcare administration, business or a related field preferred.
• Certification by the National Association of Medical Staff Services (NAMSS) as a Certified Provider Credentialing Specialist (CPCS) / Certified Professional Medical Services Management (CPMSM).
• Certification from NAMSS (e.g., CPCS - Certified Provider Credentialing Specialist) preferred.

Salary : $26 - $34