[Hiring] Credentialing Specialist @usebridge.com
Role Description The Credentialing Specialist plays a critical role in ensuring the accuracy, efficiency, and compliance of provider credentialing processes within a growing digital health environment. This position is responsible for managing provider credentialing, enrollment, and re-credentialing with health plans, regulatory bodies, and partner organizations. The ideal candidate has a strong understanding of credentialing best practices, compliance requirements, and digital tools to streamline workflows.
- Process and manage provider credentialing applications, ensuring compliance with federal, state, and payer requirements.
- Maintain accurate and up-to-date provider records within credentialing databases and digital health platforms.
- Verify provider credentials, including licensure, certifications, education, training, and work history.
- Coordinate with internal teams and external stakeholders to ensure timely credentialing and payer enrollment.
- Monitor and track credentialing deadlines, expirations, and re-credentialing requirements.
- Identify and implement process improvements using digital tools and automation.
- Stay up-to-date with industry regulations, payer policies, and accreditation standards (NCQA, CMS, CAQH, etc.).
- Assist with audits, reporting, and data analysis related to provider credentialing and compliance.
- Support provider onboarding processes including communicating with providers directly in a professional manner to ensure a seamless experience.
Qualifications
- Bachelor's degree in healthcare administration, business, or a related field preferred.
- 2+ years of experience in provider credentialing or enrollment within a healthcare or digital health setting.
- Experience using Verifiable or Medallion preferred.
- Strong understanding of NCQA, CMS, CAQH, and payer credentialing requirements.
- Proficiency in credentialing software, databases, and digital health platforms.
- Detail-oriented with strong analytical, problem-solving, and organizational skills.
- Excellent communication and interpersonal abilities to collaborate with internal teams and external partners.
- Ability to manage multiple priorities in an evolving, technology-driven environment.
- Experience with automated credentialing workflows and digital process optimization is a plus.
Company Description