A Credential Specialist is responsible for verifying and maintaining professional credentials and licenses for healthcare providers, ensuring all practitioners meet organizational and regulatory standards. This role is critical for maintaining compliance, reducing organizational risk, and ensuring the delivery of qualified patient care.
Hiring for this role?
POST THIS JOB FOR FREE
Find more suitable candidates for this role ?
TRY FOR FREE
What is a Credential Specialist?
A Credential Specialist is a healthcare administration professional who manages the verification process for medical staff credentials, including licenses, certifications, education, and work history. They serve as gatekeepers of quality assurance by ensuring all healthcare providers meet strict competency and legal requirements before granting practice privileges within a healthcare facility. Their work directly supports patient safety and organizational compliance with accrediting bodies like The Joint Commission.
What does a Credential Specialist do?
Credential Specialists collect and review applications from healthcare providers, verifying the authenticity of documents through primary source verification. They maintain detailed databases of credentialing statuses and expiration dates, coordinating with licensing boards and educational institutions. Additionally, they prepare credentialing files for committee review, manage renewal processes, and ensure continuous compliance with state and federal regulations. They also investigate any discrepancies in applications and serve as liaisons between medical staff and credentialing committees.
Job Overview
The Credential Specialist is responsible for managing and maintaining the credentialing and re-credentialing processes for healthcare providers, ensuring compliance with federal and state regulations, as well as accreditation standards. This role requires meticulous attention to detail, strong organizational skills, and comprehensive knowledge of credentialing procedures within the US healthcare system.
Credential Specialist responsibilities include:
1. Process initial credentialing and re-credentialing applications for physicians and allied health professionals
2. Verify provider credentials including education, training, licensure, and board certifications through primary sources
3. Maintain accurate provider data in credentialing database and ensure timely updates
4. Prepare and submit credentialing files to health plans, hospitals, and other healthcare entities
5. Monitor expirables including licenses, certifications, and malpractice insurance
6. Coordinate with National Practitioner Data Bank (NPDB) and other verification services
7. Ensure compliance with NCQA, Joint Commission, and CMS standards
8. Participate in committee meetings and prepare credentialing reports
1. Minimum 2 years of credentialing experience in US healthcare setting
2. Certified Provider Credentialing Specialist (CPCS) certification or ability to obtain within 12 months
3. Thorough knowledge of NCQA standards and CMS requirements
4. Experience with CAQH ProView and PECOS systems
5. Proficiency in credentialing software (MSOW, CACTUS, or similar)
6. Strong understanding of medical staff bylaws and privileging processes
7. Excellent attention to detail and organizational skills
8. High school diploma or equivalent required
Preferred Qualifications
1. Bachelor's degree in healthcare administration or related field
2. CPCS or CPMSM certification already obtained
3. Experience with hospital credentialing and managed care organizations
4. Knowledge of state-specific credentialing requirements
5. Experience with credentialing audits and quality assurance processes
6. Background in multi-specialty medical group credentialing
7. Familiarity with telehealth credentialing requirements
Bonus Skills
1. Experience with credentialing automation tools and AI-based verification systems
2. Bilingual skills (Spanish/English)
3. Knowledge of provider enrollment processes with Medicare/Medicaid
4. Experience with credentialing for behavioral health providers
5. Understanding of value-based care credentialing requirements
6. Proficiency in data analytics and reporting for credentialing metrics
7. Experience with credentialing in multi-state healthcare systems
Real-time search for over 900 million precise talents globally, covering more than 200 countries and regions.
All categories
Ready to Hire?
Real-time search for over 900 million precise talents globally, covering more than 200 countries and regions.
Are you ready to innovate your recruitment process?
Join thousands of leading companies and experience the next generation of intelligent recruitment
No credit card required ｜ 7-day full-featured trial ｜ Dedicated customer support
Frequently Asked Questions
Your questions, answered
Everything you need to know about TalentSeek and how itcan transform your hiring process.
What is TalentSeek
TalentSeek is an AI-powered global recruitment platform designed to make hiring talent worldwide faster, smarter, and more affordable. Powered by advanced AI Agents, TalentSeek helps companies effortlessly connect with top professionals across borders — breaking human network limits and reducing hiring costs. Start hiring globally with ease. One platform, endless talent.
Who can use TalentSeek ?
TalentSeek is built for recruiters. If you are searching for Global Talent or hard-to-find talent, TalentSeek is a fit for you. We work with companies ranging from Fortune 500 to boutique recruiting agencies — and hopefully, you too.
What distinguishes TalentSeek from other recruitment tools?
TalentSeek is an AI-driven global recruitment platform that enables real-time searching of over 900 million job seekers across more than 200 countries and regions. This platform empowers companies to effortlessly connect with top professionals beyond borders, breaking the limitations of personal networks and reducing hiring costs.
Does TalentSeek have access to global candidate data?
Yes. TalentSeek has 900 million profiles across the globe from dozens of data sources. Covers over 200 countries and regions worldwide.We continue to add region-specific sources to enhance global coverage.
Is there a free trial available for TalentSeek?
Yes. To get started, use the "Start for Free" button to open the platform. Then, sign up or log in to access your account.
