Credentialing Specialist
Job description
About the role
This role supports physician credentialing, enrollment, and recredentialing across a national virtual care network. The specialist maintains application accuracy, tracks status, and coordinates activities with external agencies and payors. Success in this role depends on attention to detail, reliable communication, and adherence to NCQA, URAC, Joint Commission, and CMS standards.
Every role in this field shares a few habits: clear communication, structured thinking, and steady follow through. Teams hold regular meetings, review progress, and adjust plans. Success usually depends on how well you work with others, not just how hard you try. Successful professionals in any field share a few habits: they take notes, keep commitments, and communicate in writing. Teams value people who make their work easy to review and build on.
Key facts
What you'll do
Verify credentialing and enrollment application accuracy before submission to payors.
Monitor provider enrollment status and follow up with managed care companies to ensure timely credentialing.
Maintain CAQH profiles for the TeleMed2U Provider Network and manage distribution, receipt, and processing of applications.
Keep detailed logs of all credentialing tasks and communicate regularly with outside agencies.
Serve as a liaison to train new team members and highlight sensitive or conflicting information for review.
Prepare specialized reports and analyses as requested by the credentialing team.
Requirements
The posting states a bachelor's degree requirement. Credentialing Specialist I: High School Diploma or equivalent; credentialing experience.
Credentialing Specialist II: 3 years of credentialing experience; 1 year of healthcare experience; High School Diploma or equivalent.
Credentialing Specialist III: 1 year at TeleMed2U as a Credentialing Specialist II; 4 years minimum in credentialing and/or licensing; top performance demonstrated; excellent verbal and written communication; ability to multitask and work independently; strong attention to detail; experience with state licensure applications for multiple states.
All levels: Must comply with NCQA, URAC, Joint Commission, and CMS standards; Federal and State laws; and TeleMed2U policies.
Practical notes
Prolonged desk work and computer use are expected; ability to lift 15 lbs required.
Typical interview steps
Hiring processes usually combine a screening conversation with one or more interview rounds. Candidates can expect questions about their experience, a scenario or case, and a chance to ask their own questions. Preparation and specific examples from past work carry the most weight. Whatever the role, preparation is visible. Reviewing the company's product, the job description, and your own past work before the conversation is the strongest step.
Good to know
The role relies on standard credentialing tools and databases used in healthcare environments.
Work involves frequent interaction with regulatory bodies and payor organizations.
Attention to detail and clear communication are essential for managing provider enrollments.
The position may require multitasking across multiple provider applications and states.
Data accuracy and timely follow-up support network participation and care continuity.
Questions to ask
Worth asking in any interview: how the team measures success, who the role works with daily, what the onboarding looks like, and what the company is trying to achieve this year. Asking what past hires did well is a strong final question. Keep the list short and pick the questions that matter most to you.
Career growth
Careers in this field grow through a mix of experience, responsibility, and demonstrated results. Early years build skills; later years build ownership. Many professionals switch focus areas or companies to keep growing. Growth in any career comes from scope, results, and reputation. Take on work that is slightly uncomfortable, and make sure others can see the outcomes.