Credentialing Specialist

At Claremedica, exceptional is the standard.

Driven by our purpose to enhance the lives of the seniors in the communities where we have the privilege to work, live, and play, the Claremedica team is comprised of the brightest and best in their fields of expertise. From clinical excellence to unparalleled administrative support and beyond, we’re working together to help seniors live happier, healthier, fuller lives.

That kind of teamwork and passion for excelling can only exist in a workplace that fosters employees’ growth and wellness and where their full potential and value are realized. At Claremedica, we’re excited about great people like you. We’re even more excited to support you with the resources, training, benefits, competitive compensation, and more to help you thrive and succeed in our communities.

Opportunity awaits – welcome to Claremedica.

ESSENTIAL FUNCTIONS

The Senior Credentialing Specialist ensures healthcare providers are credentialed and enrolled with necessary payers while maintaining compliance and facilitating efficient operations. This role combines meticulous data management, regulatory oversight, onboarding support, and proactive communication to support provider readiness.

DUTIES AND RESPONSIBILITIES

• Assist in the onboarding of new providers, coordinating credentialing tasks with recruitment, credentialing teams, and internal departments to support seamless integration into the network as part of provider onboarding processes.
• Conduct primary source verification of licenses, certifications, and board credentials via CAQH, PECOS, NPPES, state boards, NPDB, etc.
• Verify all provider documentation including state licensure, DEA, professional health insurance, CME credits, and background screenings.
• Screen applications for completeness, identify discrepancies, and communicate with providers to collect missing information in a timely manner.
• Prepare and submit payer credentialing/enrollment packets (e.g. Medicare, Medicaid, commercial insurers) and support revalidation requests.
• Process and prepare initial credentialing and recredentialing applications for healthcare providers, ensuring full completion and accuracy.
• Collaborate cross‑functionally with medical staff offices, HR, recruiters, finance, and the director to align credentialing timelines with onboarding and billing.
• Stay current on evolving credentialing regulations and payer requirements.
• Support provider inquiries, offering professional, clear communication and status updates throughout the credentialing process.
• Ensure compliance with NCQA, CMS, and other regulatory standards.
• Conducts ongoing monitoring of provider rosters, directories, and downstream systems.
• Track enrollment statuses and follow up to ensure timely approvals
• Track and manage expirations, issuing reminders and initiating renewal workflows to ensure continuous compliance.
• Maintain accurate provider records and databases, updating credentialing systems (e.g. Medallion).
• Preserve strict confidentiality of sensitive provider information in adherence to HIPAA and organizational policies.
• Performs other duties as assigned.

QUALIFICATIONS/REQUIREMENTS

• Associate’s degree in healthcare administration, Business, or a related field.
• Minimum of 2 years in healthcare credentialing or provider enrollment.
• Familiarity with credentialing software and databases.
• Subject matter expertise in provider credentialing, Medicare/Medicaid provider

enrollment, provider data issues, and healthcare operations broadly and editing abilities.

• Strong oral/written communication and presentation skills a must.
• Excellent time management skills with proven ability to effectively manage multiple tasks

and priorities at one time.

• Ability to adapt and respond to changes in environment and priorities.
• Ability to prioritize and plan work independently.
• Good judgment and problem-solving skills.
• Must demonstrate proficiency in Microsoft Excel, Word, and Outlook, using these tools regularly and accurately to support daily workflows
• Attention to detail a must.

WORKING CONDITIONS

General office working conditions.

PHYSICAL DEMANDS

To perform this job successfully, an individual must be able to perform each essential duty

satisfactorily. The requirements listed above are representative of the knowledge, skill, and/or

ability required. Reasonable accommodation may be made to enable individuals with disabilities

to perform the essential functions.

WORK ENVIRONMENT

The work environment characteristics described here are representative of those that must be met by an employee to successfully perform the essential functions of his job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions. 

TRAVEL

No travel required. This role is entirely office-based (or remote/hybrid as applicable) and does not involve in‑person visits or field assignments