ObjectWin Technology
Credentialing Specialist
Remote
6 Month contract
Job Summary The Provider Credentialing Specialist is responsible for managing all aspects of provider credentialing and recredentialing in compliance with state and regulatory requirements. This role partners closely with providers, retail chains, internal stakeholders, and regulatory bodies to ensure accurate, timely, and compliant credentialing decisions while supporting organizational growth and operational objectives.
Key Responsibilities
Develop and maintain productive relationships with providers, retail chains, strategic partners, and their staff.
Educate providers on industry-standard credentialing requirements by leveraging internal team knowledge and resources.
Establish and manage provider relationships to obtain required regulatory and credentialing documentation.
Independently review and validate documentation to ensure compliance with applicable state and regulatory requirements.
Oversee and manage assigned provider files within the CVO partner system.
Track in-progress credentialing files, identify missing documentation, and ensure timely completion for new and existing providers.
Research, analyze, and resolve complex credentialing issues and escalations, collaborating with internal and external partners as needed.
Use analytical and investigative skills to evaluate information from regulatory agencies, legal documents, and providers related to sanctions or malpractice claims.
Compile complete and accurate credentialing packets for presentation to the Credentialing Committee to support informed decision‑making.
Maintain accurate provider data and ensure the integrity of all shared credentialing information.
Escalate issues appropriately and drive resolution in partnership with relevant business areas.
Gather and assess documentation required by the Legal Department for dispute resolution processes involving denied or terminated providers.
Prepare clear, professional, and concise correspondence for providers, retail chains, and office staff.
Act as an internal subject matter resource for credentialing‑related inquiries.
Demonstrate understanding of organizational strategy and contribute to achieving growth and operational goals.
Required Qualifications
Bachelor's degree in a related field OR 4 years of relevant functional experience in lieu of a degree.
Experience working directly with providers and office staff on credentialing policies and procedures.
Demonstrated professionalism and leadership when managing conflict, controversy, and escalated situations.
Strong analytical, investigative, and problem‑solving skills.
Ability to exercise discretion and independent judgment in day‑to‑day responsibilities.
Excellent written and verbal communication skills, with the ability to influence and collaborate effectively.
Strong attention to detail with proven multitasking and organizational capabilities.
Customer‑focused mindset with the ability to balance provider needs and corporate objectives.
Ability to work independently as well as collaboratively in a team environment.
Preferred Skills (Nice to Have)
Experience working with CVO systems or credentialing databases
Familiarity with healthcare regulatory and compliance standards
Prior experience supporting Credentialing Committees
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Job Summary The Provider Credentialing Specialist is responsible for managing all aspects of provider credentialing and recredentialing in compliance with state and regulatory requirements. This role partners closely with providers, retail chains, internal stakeholders, and regulatory bodies to ensure accurate, timely, and compliant credentialing decisions while supporting organizational growth and operational objectives.
Key Responsibilities
Develop and maintain productive relationships with providers, retail chains, strategic partners, and their staff.
Educate providers on industry-standard credentialing requirements by leveraging internal team knowledge and resources.
Establish and manage provider relationships to obtain required regulatory and credentialing documentation.
Independently review and validate documentation to ensure compliance with applicable state and regulatory requirements.
Oversee and manage assigned provider files within the CVO partner system.
Track in-progress credentialing files, identify missing documentation, and ensure timely completion for new and existing providers.
Research, analyze, and resolve complex credentialing issues and escalations, collaborating with internal and external partners as needed.
Use analytical and investigative skills to evaluate information from regulatory agencies, legal documents, and providers related to sanctions or malpractice claims.
Compile complete and accurate credentialing packets for presentation to the Credentialing Committee to support informed decision‑making.
Maintain accurate provider data and ensure the integrity of all shared credentialing information.
Escalate issues appropriately and drive resolution in partnership with relevant business areas.
Gather and assess documentation required by the Legal Department for dispute resolution processes involving denied or terminated providers.
Prepare clear, professional, and concise correspondence for providers, retail chains, and office staff.
Act as an internal subject matter resource for credentialing‑related inquiries.
Demonstrate understanding of organizational strategy and contribute to achieving growth and operational goals.
Required Qualifications
Bachelor's degree in a related field OR 4 years of relevant functional experience in lieu of a degree.
Experience working directly with providers and office staff on credentialing policies and procedures.
Demonstrated professionalism and leadership when managing conflict, controversy, and escalated situations.
Strong analytical, investigative, and problem‑solving skills.
Ability to exercise discretion and independent judgment in day‑to‑day responsibilities.
Excellent written and verbal communication skills, with the ability to influence and collaborate effectively.
Strong attention to detail with proven multitasking and organizational capabilities.
Customer‑focused mindset with the ability to balance provider needs and corporate objectives.
Ability to work independently as well as collaboratively in a team environment.
Preferred Skills (Nice to Have)
Experience working with CVO systems or credentialing databases
Familiarity with healthcare regulatory and compliance standards
Prior experience supporting Credentialing Committees
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