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Credentialing Specialist Job Description: Top Duties and Qualifications

Edited by Indeed Employer Content Team
Last updated November 6, 2025
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Indeed’s Employer Resource Library helps businesses grow and manage their workforce. With over 15,000 articles in 6 languages, we offer tactical advice, how-tos and best practices to help businesses hire and retain great employees.

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4 min read

A 10871900credentialing6.8credentialing specialist6.01medical records1.04healthcare1.02provider enrollment specialist0.92495022803729.4524.9047.55HOURLY565107582025-10-012025-10-312025-09-012025-09-302025-11-05Credentialing Specialist, or Physician Credentials Verification Coordinator, provides administrative assistance and verifies licenses and credentials in the healthcare industry. Their duties include keeping detailed records of medical staff members, maintaining databases and ensuring staff members possess legal licenses and credentials to work in their chosen fields.

10871900credentialing6.8credentialing specialist6.01medical records1.04healthcare1.02provider enrollment specialist0.92495022803729.4524.9047.55HOURLY565107582025-10-012025-10-312025-09-012025-09-302025-11-05Credentialing Specialist duties and responsibilities

Credentialing Specialists have many important duties, as they’re responsible for ensuring that the facilities in which they work and represent are fully compliant with all state and federal regulations at all times. They must also ensure that every staff member is legally licensed and/or credentialed and up to date with the latest medical policies and procedures.

Additional duties and responsibilities of a Credentialing Specialist include:

  • Create and maintain licensing, credentials and insurance records
  • Conduct research on updated state and federal regulations and policies
  • Release information to requesting agencies and public inquiries when required by law
  • Help develop internal credentialing processes
  • Monitor license and credential expiration dates and advise staff members of required “renew by” dates
  • Ensure the facility and staff members are maintaining compliance with regulatory and accrediting institutions

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Credentialing Specialist Job Description Examples

Example 1

JOB Description

TITLE:Credentialing Coordinator, Woods Staffing, LLC ( Woods Staffing )

dba Aurora Staffing

Reports TO:Executive Director, Woods Staffing, LLC and Chief Recruiter

Primary Function:

The Credentialing Coordinator is responsible for Woods Staffing, LLC organization wide talent onboarding. Woods Staffing, LLC includes Woods Services, Inc., Archway Programs, Inc., Legacy Treatment Services, Inc., Allies, Inc., Brian s House, Inc., and Woods Community Services, LLC. The Credentialing Coordinator will direct and influence how, the Woods Staffing team credentials, on boards and monitors Direct Support Professionals (DSPs) and substantially similar positions and will partner closely with Woods Staffing, LLC Director and Chief Recruiter and the recruiting teams to accomplish this critical organizational growth goal.

Duties & Responsibilities

  • Process all onboarding paperwork for new hires.
  • Assists with fingerprinting new hire employees. Processes and tracks clearances (PA child abuse, NJ child abuse, PA Legal History, FBI, etc )
  • Organizes the new employee personnel file and verifies that required documentation is accurate including I-9, W-4, disclosure forms, job description sign-off, facilitates and processes Act 168s,employment references, verification of employment and licenses and/or certifications required for employment
  • Assist with survey/audits as it relates to Personnel files.
  • Ensures Form I-9s are files correctly for active and terminated employees.
  • Responsible for keeping the data for the off-site files up to date and accurate
  • Processes and tracks medical appointments to ensure compliance
  • Consistently exhibits behavior and communication skills that demonstrate the core values of Woods Staffing, LLC dba Aurora Staffing.
  • Ensures the onboarding process meets all requirements and adheres to all employment laws/regulations.
  • Provides prompt customer services to internal contacts, as well as candidates, to ensure an outstanding onboarding experience. This includes, but is not limited to, answering telephone calls and emails from candidates, coworkers, and managers regarding new hire processes, paperwork requirements, and background checks; answering questions related to onboarding policies and establishes and maintains positive working relationships with management and internal and external customers.
  • Identifies potential onboarding issues or concerns; researches, provides clarification, and facilitates problem resolution.
  • Notifies management and/recruiters regarding onboarding process issues; collaborates and advises as appropriate and escalates issues and concerns. Serves as liaison between Woods Staffing, LLC dba Aurora Staffing, Affiliate medical centers and Affiliate training departments to ensure a seamless onboarding process for those being hired.
  • Coordinate and complete new hire files in a timely manner.
  • Handle additional tasks as assigned.
  • Upholds the confidentiality of all records.

Qualification & Skills

  • High School Diploma Required, Associate or Bachelor s degree preferred.
  • Minimum of 2 (two) years Human Resources experience in recruitment, onboarding, employment compliance preferred within a Staffing Agency Environment
  • Strong computer skills and proficiency in MS Word, Excel, and Outlook required; intermediate computer skills and experience with applicant tracking systems preferred
  • Highly organized with a strong attention to detail.
  • Must have ability to travel two to three times per week to Affiliate offices both in PA and NJ.
  • Must have a valid driver s license.

Job Type: Full-time

Pay: $45,000.00 - $50,000.00 per year

Benefits:
  • 401(k)
  • 401(k) matching
  • Dental insurance
  • Employee assistance program
  • Flexible schedule
  • Flexible spending account
  • Health insurance
  • Life insurance
  • Paid time off
  • Tuition reimbursement
  • Vision insurance
Schedule:
  • 8 hour shift
  • Monday to Friday
  • Overtime



Ability to commute/relocate:
  • Hainesport, NJ 08036: Reliably commute or planning to relocate before starting work (Required)

Experience:
  • Credentialing: 2 years (Required)
  • Human resources: 2 years Location: Hybrid remote in Hainesport, NJ 08036

Example 2

Who is Bridging Access to Care, Inc.:Bridging Access to Care, Inc. is a nonprofit, multi-service, community-based behavioral health care organization.

Maintained an unwavering commitment to serve low-income communities of color since 1986, BAC is Brooklyn s oldest nonprofit prevention, treatment, and health service organization. We provide comprehensive HIV/AIDS, mental health, and substance abuse-related social services to under-served racial and ethnic minority communities in the borough.

Bridging Access to Care, Inc. offers a competitive salary package, including health insurance, retirement plan, paid time off, and opportunities for professional development.

JOB Summary: Under the direct supervision of the Director of Revenue Cycle Management the Part-time Healthcare Credentialing Specialist will assist in maintaining active status for all providers and facilities by successfully completing initial and subsequent credentialing packages as required for New York State Office of Mental Health-licensed behavioral health clinics, Regulation and Quality Control of Chemical Dependence Services and Compulsive Gambling Services, CORE/HCBS, CMS Medicare, Medicaid and Managed Care Organizations. This will include maintaining individual provider and facility s updated profiles in various health insurance portals, CAQH, PECOS, NPPES, Navinet, Availity, PlaySpan, CMS databases, commercial plans, and Managed Care Organizations portals. Assist new individual provider completing application for National Provider Identifier (NPI).

Duties AND Responsibilities:

  • Maintain individual provider files to include up to date information needed to complete the required governmental and commercial payer credentialing applications.
  • Maintain contracted Managed Care Organizations, commercial payers, CMS Medicare, Medicaid, PECOS, NPPES, and CAQH tracking log to ensure all necessary portals logins are active and available.
  • Work with individual providers to ensure each provider s CAQH database files are updated timely according to the schedule published by CMS Medicare/ Medicaid and Managed Care Organizations regulations.
  • Assist new individual provider completing application for National Provider Identifier (NPI).
  • Terminating enrollment with government and commercial payers upon resignation or termination of providers
  • As directed, provide updated demographic information with supporting documents to outside participants, such as commercial managed care plans and contracted billing entities.
  • Work closely with the Director and Assistant Director of the Behavioral Health Programs to ensure all individual providers are credentialed and recredentialed timely.
  • Maintain accurate provider profiles on CAQH, PECOS, NPPES, and CMS databases.
  • Responsible of ensuring provider collected information is current and accurate.
  • Responsible of coordinating, monitoring, and maintaining the credentialing and re-credentialing process, re-credentialing, and contracting processes with insurance companies.
  • Insuring interpretation and compliance with the appropriate accrediting and regulatory agencies.
  • Contacting Managed Care Organizations, Commercial plans, CMS Medicare, and Medicaid and/or other insurance agencies to follow up on several stages in credentialing.
  • Identifies potential onboarding issues or concerns; research, provides clarification, and facilitates problem resolution.
  • Responsible of collaborating and advising as appropriate to limit company legal liability and escalates non-compliance issues and concerns.
  • Identifies trends and issues with the onboarding process flow; makes improvement recommendations to department director.
  • Keep track of the expiration date for the state DEA license, Board certification, and Malpractice insurance of individual providers.
  • Other tasks as needed to support the Revenue Cycle Management Department and BAC.

Knowledge, Skills, AND Abilities:

  • Excellent interpersonal communication skills and the ability to empathize with others.
  • Possesses excellent judgment and the ability to maintain professional relationships and boundaries when working with internal and external colleagues and organizations.
  • Minimum Intermediate computer proficiency in Microsoft office programs, internet, email and EHR systems.
  • Strong verbal and written communication skills
  • Behavioral health knowledge is a plus.

Education:

  • Minimum: High School Diploma or equivalent and 5 years experience in healthcare administration, credentialing individual providers and facilities.
  • Associate and minimum 2 years experience in healthcare administration, credentialing individual providers and facilities.

WORK Experiences:

  • Minimum: Two (2) year experience in healthcare credentialing and enrolling individual providers through PECOS, NPPES, CAQH, Managed Care Organization, commercial plans, and various clearinghouse s portals like Navinet and Availity.
  • Two (2) years experience tracking license and certification expirations for all providers
  • Two (2) years direct credentialing and provider enrollment experience (required)

Job Type: Part-time

Pay: $25.00 per hour

Schedule:
  • Monday to Friday



Ability to commute/relocate:
  • Brooklyn, NY 11226: Reliably commute or planning to relocate before starting work (Required)

Education:
  • High school or equivalent (Required)

Experience:
  • Healthcare Administration: 2 years (Preferred)
  • Healthcare Credentialing: 2 years (Required)
  • CAQH, PECOS, NPPES database: 2 years Location: Hybrid remote in Brooklyn, NY 11226

Example 3

Credentialing Specialist - Urgent Opening
  • Job Title:Credentialing Specialist
  • 50 Water St. New York, NY 10004
  • Shift Schedule: 9:00 AM – 5:00 PM (08Hrs. Day shift)
  • Guaranteed Hours: 40/Week.
  • Duration of the Contract: 13 Weeks (with Highly Possible Extension).

Schedule Notes: Credentialing:
  • Responsible for all aspects of provider credentialing and re-credentialing.
  • License Renewals: Ensures that physician licenses are renewed prior to expiration.
  • Primary Source Verification: Completes primary source verification for new and existing providers to ensure due diligence.
  • Records Management: Maintains assigned physician files, updating each item/action as processed.
  • Utilizes database status/alert and other report functions, software tools and links to scanned documentation.
  • Ensures that information is current and accurate.
  • Credentialing Standards: maintains consistency in database entry to ensure accurate and consistent processes.
  • Back-up Coverage: provide credentialing back-up for other members of the credentialing group.

Regards:
Yogesh
Email - [website]
Contact - [phone number]

Job Type: Contract

Pay: $22.00 - $28.00 per hour

Expected hours: 40 per week

Schedule:
  • 8 hour shift
  • Day shift



Experience:
  • auditing: 2 years (Required)
  • Credentialing Specialist: 1 year (Required)


Work In person

Example 4

Credentialing Specialist, Provider Services

  • Only open to candidates residing in California
  • Opportunity to make a difference in your community
  • Position not eligible for sponsorship

General Description
Serve as the focal point for HPSM s credentialing process to outside parties. Oversee the Health Plan of San Mateo s (HPSM) credentialing process, ensure that contracted providers maintain compliance with HPSM s credentialing requirements, and make recommendations for improvements to the credentialing process.

Duties & Responsibilities

Essential Functions:

  • Research, analyze, and evaluate credentialing applications, ensuring all relevant information has been submitted; distribute and receive the application.
  • Ensure credentialing applications are tracked and monitored for adherence to timelines.
  • Enter demographic and credentialing information into credentialing software in a timely and accurate manner.
  • Monitor and document credentialing efforts.
  • Maintain a current copy of and quickly learn/understand HPSM s credentialing policies and procedures, ensuring that policies and procedures are followed, and that applications and reapplications are processed thoroughly and expediently.
  • Create and construct files; prepare files for review.
  • Assemble relevant data and prepare scheduled and ad-hoc reports as needed.
  • Ensure re-credentialing of providers according to policies and procedures.

Secondary Functions:

  • Continuously improve credentialing process.
  • Make recommendations on improvements to the credentialing policies and procedures, based on experiences and/or evolving regulatory requirements (i.e. state contract, Knox-Keene requirements, NCQA guidelines).
  • Perform other duties as assigned.

Requirements

These are the qualifications typically needed to succeed in this position. However, you don t need to meet every requirement to apply.

Education and experience

  • Two (2) years of work in a clerical/administrative function in a health services/managed care setting.
  • A Bachelor s degree in an appropriate health or business field and credentialing experience is preferred.

Certification:

  • CMSC/CPCS certification is a plus, but not required.

Knowledge of:

  • Personal computers and proficiency in Microsoft Office Suite applications, including Outlook, Word, Excel, and PowerPoint.
  • Medi-Cal and Medicare preferred.

Ability to:

  • Work cooperatively with others.
  • Work as part of a team and support team decisions.
  • Communicate effectively, both verbally and in writing.
  • Adapt to changes in requirements/priorities for daily and specialized tasks
  • Work in a fast-paced, highly pressured, and changing environment.
  • Compile, verify and follow-up on information.
  • Quickly learn the credentialing process and software.
  • Create basic reports.
  • Be resourceful and use initiative to resolve problems/issues.
  • Communicate effectively with others, both verbally and in writing.
  • Accurately perform highly detailed work.
  • Organize/prioritize tasks.
  • Deliver results within set deadlines.
  • Attend meetings outside of regular work hours as necessary.

Salary and benefits

The starting salary rangeis $24.30 - $31.59 per hour, depending on the candidate s work experience.

Excellent benefits package includes:

  • HPSM-paid premiums for employee s medical, dental and vision coverage (employee pays 10% of each dependent s premiums)
  • Fully paid life, AD&D and LTD insurance
  • Retirement plan (HPSM contributes equivalent of 10% of annual compensation)
  • 12 paid holidays a year, 12 paid sick days a year and paid vacation starting at 16 days a year
  • Tuition reimbursement plan
  • Employee wellness program

It is HPSM's policy to provide equal employment opportunity for all applicants and employees. HPSM does not unlawfully discriminate based on race, religion, color, national origin, ancestry, physical disability, mental disability, medical condition, marital status, sex, age, sexual orientation, veteran status, registered domestic partner status, genetic information, gender, gender identity, gender expression, or any other characteristic protected by applicable federal, state, or local law. HPSM also prohibits discrimination based on the perception that an applicant or employee has any of those characteristics or is associated with a person who has or is perceived to have any of those characteristics.

Job Type: Full-time

Pay: $24.30 - $31.59 per hour

Benefits:
  • 401(k)
  • AD&D insurance
  • Dental insurance
  • Disability insurance
  • Employee assistance program
  • Employee discount
  • Flexible spending account
  • Free parking
  • Health insurance
  • Health savings account
  • Life insurance
  • Paid time off
  • Parental leave
  • Referral program
  • Retirement plan
  • Tuition reimbursement
  • Vision insurance
Schedule:
  • Monday to Friday



Ability to commute/relocate:
  • South San Francisco, CA 94080: Reliably commute or planning to relocate before starting work (Required)

Experience:
  • Microsoft Office: 1 year (Preferred)
  • Microsoft Word: 1 year (Preferred)
  • Healthcare Administration: 2 years Location: Hybrid remote in South San Francisco, CA 94080

Example 5

Credentialing Medical Assistant

We are looking to hire an organized credentialing medical assistant to assist us with administrative tasks pertaining to our practitioners' credentialing. The credentialing medical assistant will organize, maintain, and verify all aspects of current onboarding providers and will also be responsible for tracking the expiration of all licenses, CAQH revalidations, and insurance re-credentialing requests while maintaining accurate notes and documentation. The credentialing medical assistant will need to establish and maintain a good relationship with insurance representatives and answer phone and email inquiries regarding the providers.

To be successful in this role you should ensure the accuracy and completeness of all information. Preferred candidates will be reliable, energetic, and have excellent people skills.
Credentialing Coordinator Responsibilities:

  • Processing initial credentialing and re-credentialing applications.
  • Following up on pending applications.
  • Screening practitioners' applications and supporting documentation to ascertain their eligibility.
  • Collecting information from the National Practitioner Data Bank (NPDB), the applicant and their malpractice insurer, and other relevant sources.
  • Identifying discrepancies in information and conducting follow-ups.
  • Presenting applications to the facility s Credentialing Committee.
  • Responding to health plan provider inquiries.
  • Capturing primary source documentation in computer databases.
  • Ensuring compliance with applicable laws, regulations, procedures, and policies.

Credentialing Coordinator Requirements:

  • High school diploma, GED, or suitable equivalent.
  • 2+ years of credentialing experience with knowledge of medical credentialing and hospital privileges standards and procedures.
  • Knowledge of PECOS/NPPES, NV Medicaid and CAQH
  • Excellent verbal and written communication skills.
  • Proficient with Microsoft Office Word, Excel & Adobe
  • Ability to focus for extended periods.

Job Type: Full-time

Pay: $19.00 - $22.00 per hour

Benefits:
  • 401(k)
  • Dental insurance
  • Employee assistance program
  • Health insurance
  • Paid time off
  • Vision insurance
Schedule:
  • 8 hour shift
  • Day shift
  • Monday to Friday



Ability to commute/relocate:
  • Las Vegas, NV 89113: Reliably commute or planning to relocate before starting work (Preferred)

Experience:
  • Microsoft Office: 1 year (Preferred)
  • Microsoft Word: 1 year Location: In person
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What does a 10871900credentialing6.8credentialing specialist6.01medical records1.04healthcare1.02provider enrollment specialist0.92495022803729.4524.9047.55HOURLY565107582025-10-012025-10-312025-09-012025-09-302025-11-05Credentialing Specialist do?

Credentialing Specialists provide administrative support in healthcare settings. Their job is to verify that all medical staff members’ credentials and licenses are valid and up to date. They operate maintain databases and advise staff members on renewal dates for licenses and credentials to help ensure they can continue to work legally without lapses.

Credentialing Specialists often work in medical administrative offices or hybrid/work-from-home settings. They usually work independently unless they oversee other staff members, such as Credentialing Coordinators. They must research to ensure they’re up to date on medical policy, local licensing and certification requirements.

10871900credentialing6.8credentialing specialist6.01medical records1.04healthcare1.02provider enrollment specialist0.92495022803729.4524.9047.55HOURLY565107582025-10-012025-10-312025-09-012025-09-302025-11-05Credentialing Specialist skills and qualifications

A successful 10871900credentialing6.8credentialing specialist6.01medical records1.04healthcare1.02provider enrollment specialist0.92495022803729.4524.9047.55HOURLY565107582025-10-012025-10-312025-09-012025-09-302025-11-05Credentialing Specialist should possess these various prerequisite skills and qualifications needed to effectively perform job duties and tasks:

  • Ability to meet strict deadlines
  • Attention to detail
  • Good communication skills
  • Knowledgeable in policies, laws and procedures
  • Strong computer skills
  • Proficiency in database management (if applicable)
  • Willingness to work as a team player
  • Good organizational skills

Credentialing Specialist experience requirements

A Credentialing Specialist’s experience requirements depend on whether an employer or hiring manager is looking for entry-level or experienced candidates. Entry-level Credentialing Specialists typically receive on-the-job training and must have at least a high school diploma or GED equivalent and computer experience. In some cases, employers may hire entry-level applicants as Credentialing Coordinators with the opportunity to move up into specialist positions. In this scenario, a coordinator may work under a specialist to gain skills and experience.

For advanced positions, applicants typically need two to three years of previous employment in medical administration or as a 10871900credentialing6.8credentialing specialist6.01medical records1.04healthcare1.02provider enrollment specialist0.92495022803729.4524.9047.55HOURLY565107582025-10-012025-10-312025-09-012025-09-302025-11-05Credentialing Specialist and a strong knowledge of data systems. Credentialing Specialists must often maintain large databases containing confidential employee information, so they may need previous experience creating databases and/or inputting data (data entry).

10871900credentialing6.8credentialing specialist6.01medical records1.04healthcare1.02provider enrollment specialist0.92495022803729.4524.9047.55HOURLY565107582025-10-012025-10-312025-09-012025-09-302025-11-05Credentialing Specialist education and training requirements

A Credentialing Specialist usually needs a high school diploma or equivalent, along with an associate degree in healthcare or business administration. In some situations, employers may hire entry-level Credentialing Specialists and allow them to receive on-the-job training and work while earning their degrees and/or certifications.

While not a hard requirement for every Credentialing Specialist job, some employers prefer that potential candidates hold Certified Provider Credentialing Specialist (CPCS) certifications. To qualify for the CPCS exam, an applicant must have at least three years of experience in medical services working for the same employer for at least 12 consecutive months.

Credentialing Specialist salary expectations

According to Indeed Salaries, the average salary for a Credentialing Specialist is $40,181. It’s important to note that this is an average, and specific salary amounts can vary based on geographical location, company preferences and an individual’s overall experience.

Credentialing Specialist salary expectations

2025-10-019.4524.9047.55HOURLY
  • Common salary: 24.90 HOURLY
  • Typical salaries range from 9.45 - 47.55 HOURLY
  • Find more information on Indeed Salaries

*Indeed data – 2025-10-01

Job description samples for similar positions

If this job description isn’t exactly what you’re looking for, consider some of these similar positions:

Credentialing Specialist job description FAQs

Here are some common frequently asked questions pertaining to Credentialing Specialist job positions:

What’s the difference between a Credentialing Specialist and a Credentialing Coordinator?

The main difference between a Credentialing Specialist and a Credentialing Coordinator is seniority. Both positions generally have similar work experience and training, but a specialist is an advanced position that often requires two to three years of experience and an additional Credentialing Specialist certification.

How much does the CPCS exam cost?

A CPCS exam application costs $400 for National Association Medical Staff Services (NAMSS) members and $525 for nonmembers. Single recertification testing costs $175 for members and $325 for nonmembers, and dual certificant recertifications cost $200 for members and $350 for nonmembers.

What should you look for in a Credentialing Specialist resume?

When reviewing a Credentialing Specialist resume, look for past medical administration or business administration experience, along with education history. Also, look for certifications. In some cases, employers require all Credentialing Specialists hold specialist certifications through the National Association of Medical Staff Services (NAMSS), while others may prefer entry-level candidates.

Why is a Credentialing Specialist important?

Credentialing Specialists are highly essential in the healthcare industry because they’re responsible for verifying that physicians, nurses and other medical personnel have the appropriate licensing to work in their fields. They also ensure facilities comply with and follow all state and federal guidelines.

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