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Job description
Credentialing Specialist/AnalystThe Credentialing Specialist supports a healthcare credentialing program by helping ensure compliance with federal, state, local, and accreditation requirements. This position evaluates practitioners and facilities entering the provider network, conducts ongoing provider reviews, analyzes credentialing data, and assists with audits of delegated and non-delegated providers.Candidates must reside in Texas. Local candidates are preferred and may be required to work onsite. Candidates located outside the local area may be considered for fully remote work. Remote employees must have reliable high-speed internet and a secure work environment. A computer setup with two monitors, a keyboard, mouse, and webcam is required.Build and maintain relationships with external vendors and credentialing partners. Manage reports within external database portals, analyze information, confirm accuracy, and present findings to internal teams. Assist with oversight of delegated and non-delegated provider and facility data. Gather, analyze, and report provider information for directories, billing needs, member support, and other internal or external requests. Ensure practitioners and facilities are properly evaluated when entering the provider network. Conduct ongoing reviews of participating providers. Track credentialing applications accurately and follow up on outstanding items or delays. Assist with credentialing audits and identify opportunities for process improvement. Provide recommendations related to data accuracy, collection processes, and audit findings. Respond to questions from providers and provider groups or direct inquiries to the appropriate department. Maintain strict confidentiality regarding provider credentials, status, and personal information. Follow applicable credentialing policies, procedures, and state-specific requirements. Communicate credentialing delays, concerns, or issues to management. Support additional audits and special projects as needed. Perform other duties as assigned.Advanced Microsoft Excel skills, including VLOOKUPs, complex formulas, functions, and data analysis. Experience supporting credentialing, provider data, healthcare operations, or a related function preferred. Understanding of healthcare credentialing requirements and accreditation standards preferred. Strong analytical, problem-solving, and relationship-building skills. Ability to research information, evaluate findings, and form conclusions independently. Ability to manage multiple priorities and deadlines in a fast-paced environment. Strong attention to detail and commitment to accuracy. Clear and professional written and verbal communication skills. Ability to explain complex processes clearly. Strong planning, organization, documentation, and time-management skills. Ability to collaborate effectively with internal teams, providers, vendors, and other external stakeholders.
Worksite address
dallas, TX, 75201, US
Who can apply
Review the original listing for work authorization, qualifications and employer requirements.