Credentialing Specialist

Responsibilities

• Verify and maintain the qualifications, licenses, and certifications of healthcare providers, ensuring they meet regulatory, payer, and organizational standards.
• Review and authenticate primary source documents such as medical licenses, board certifications, malpractice insurance, and state registrations; monitor credentialing deadlines and maintain accurate provider data within compliance guidelines.
• Work in a hybrid role based in Minnesota; 1-2 days in the office in Minnetonka, MN is expected. Only considering individuals that live in Minnesota.
• Salary: $55,000 – $65,000 DOE.
• Demonstrate a high level of autonomy, strong attention to detail, and the ability to manage multiple complex timelines independently.

• Review and verify primary source documents including medical licenses, board certifications, malpractice insurance, and other credentials to ensure accuracy and validity.

• Collect and compile credentialing applications for initial enrollment and re-credentialing.

• Input provider information into credentialing systems and maintain accurate, audit-ready records.

• Stay current on federal, Minnesota state, DHS/EIDBI, and payer credentialing requirements.
• Ensure credentialing practices adhere to regulatory and accreditation standards.

• Prepare and submit credential applications to commercial and government payers.
• Conduct proactive follow-up to ensure timely enrollment and minimize revenue disruption.

• Perform periodic internal audits of credentialing files.
• Identify discrepancies and ensure corrective action when needed.

• Coordinate with providers, leadership, payers, and internal departments to resolve credentialing issues efficiently.

• Monitor credential expiration dates and notify providers of upcoming renewal requirements to prevent enrollment lapses.

• Timely submission of initial credentialing and re-credentialing applications
• Zero lapse rate in provider licensure and payer enrollment
• Reduction in enrollment turnaround time
• Accuracy rate of credentialing files (audit-ready standard)
• Minimization of revenue disruption due to credentialing delays
• Proactive tracking and reporting of credentialing status

This role plays a direct role in protecting revenue cycle stability and compliance integrity.

• Attention to detail:
  Ability to accurately review and verify complex medical and regulatory documentation.
• Strong organizational skills:
  Effectively manage multiple provider enrollments and renewal timelines.
• Excellent communication skills:
  Communicate clearly with providers, payers, and internal stakeholders.
• Analytical ability:
  Identify discrepancies and proactively resolve issues.
• Knowledge of healthcare regulation:
  Understanding of federal, Minnesota licensing requirements, pay policies, and accreditation standards.

• High school diploma or equivalent required.
• 3–5 years of experience in medical staff credentialing, provider enrollment, or a similar healthcare administrative role.

• Associate or bachelor’s degree in healthcare, business administration, or related field.
• Certified Provider Credentialing Specialist (CPCS) certification strongly valued.
• Experience in hospital systems or complex healthcare organizations (4+ years preferred).
• Behavioral health experience.

• Prolonged periods sitting at a desk and working on a computer.

• Generous PTO
• Paid holidays
• Medical, dental, and vision with employer contribution
• 401(k) with employer match
• Employer-paid life and disability insurance

Founded in 1996 by parents seeking the highest quality treatment for children and adolescents with autism spectrum disorder (ASD), Minnesota Autism Center (MAC) provides therapeutic services for individuals ages 18 months to 21 years. MAC serves approximately 370–400 clients across 18 centers throughout Minnesota, offering center-based and in-home services including ABA therapy, speech therapy, occupational therapy, diagnostic assessment, and family therapy.

MAC is an Equal Opportunity Employer and does not discriminate in terms or conditions of employment on the basis of sex (including pregnancy, childbirth, and related medical conditions), race, traits associated with race (including hair texture and style), color, national origin, religion, creed, age once having reached the age of majority, sexual orientation, gender identity, gender expression, military status, veteran status, disability, marital status, familial status, genetic information, status with respect to public assistance, or any other characteristics that are protected by federal, state, or local laws.