Credentialing Specialist

JCCA is seeking a detail-oriented and highly organized Credentialing Specialist to join our Human Resources team. In this role, you will play an important part in ensuring that our clinical practitioners are appropriately credentialed and enrolled so they can provide high-quality services to the children, youth, and families we serve.

Working closely with the Managed Care Supervisor, Human Resources onboarding team, clinical providers, program leadership, and external credentialing vendors, the Credential Specialist will coordinate the credentialing and re-credentialing process from application through completion. Your attention to detail, follow-through, and ability to identify and resolve issues will help ensure timely onboarding and compliance with licensing, accreditation, and regulatory requirements.

Summary of Responsibilities:

• Manage credentialing and enrollment data by entering, updating, and maintaining accurate provider information in systems and databases, including CAQH, PECOS, NPPES, and MMIS.
• Coordinate provider credentialing and re-credentialing activities, ensuring applications and supporting documentation are complete, accurate, and submitted timely.
• Monitor licenses and credentials, including state licenses, DEA registrations, and board certifications, and proactively track expiration dates to support timely renewals.
• Review provider files for completeness, accuracy, and compliance with JCCA policies, accreditation standards, and applicable regulatory requirements.
• Identify and resolve discrepancies and potential barriers that could delay credentialing or enrollment, escalating issues to the Human Resources Business Partner and Managed Care Supervisor when appropriate.
• Partner with clinical providers and supervisors/managers to obtain required information and documentation and provide timely responses to credentialing questions.
• Work collaboratively with JCCA’s external credentialing vendor to facilitate efficient processing and timely onboarding of clinical practitioners.
• Maintain accurate records and ensure credentialing information is consistently documented and up to date.
• Protect confidential provider information and exercise sound judgment and discretion in all credentialing-related communications.
• Perform other related duties as assigned.

Qualifications:

• Bachelor’s degree and at least two years of related experience preferred. Equivalent combinations of education, training, and experience will be considered.
• Knowledge of healthcare provider credentialing, enrollment, and accreditation principles, processes, documentation, and requirements.
• Strong attention to detail and the ability to manage multiple priorities, deadlines, and provider files simultaneously.
• Excellent verbal and written communication and strong interpersonal skills.
• Ability to analyze information, identify discrepancies, troubleshoot issues, and exercise independent judgment.
• Ability to work independently while maintaining strong communication and collaboration with the HR and clinical teams.
• Strong organizational skills and a high level of accuracy.
• Ability to maintain confidentiality and discretion when handling sensitive provider information.
• Working knowledge of Microsoft Word and Excel.
• Ability to learn and effectively use new systems, databases, and applications.