Senior Credentialing Specialist – Healthcare

Location:

Monterrey, Nuevo León

Employment Type:

Full-time

We are expanding our operations in Mexico. At One Call, we are expanding our operations in Mexico and are looking for talented professionals to join our growing team supporting healthcare operations in the United States. We are currently seeking a Senior Credentialing Specialist to support the credentialing and recredentialing of healthcare providers and help ensure our provider network meets established quality, regulatory, and accreditation standards.

If you have strong experience in healthcare credentialing, enjoy working with detailed documentation and compliance requirements, and are comfortable managing multiple priorities, we would love to hear from you.

As a Senior Credentialing Specialist, you will manage and support credentialing activities throughout the provider lifecycle, ensuring applications, documentation, verifications, and provider records are complete, accurate, and compliant.

Your responsibilities will include:

• Manage initial credentialing and recredentialing applications for healthcare providers.
• Review provider applications and supporting documentation for completeness, accuracy, and compliance.
• Conduct and document Primary Source Verification (PSV) of provider credentials.
• Verify licenses, certifications, registrations, professional liability insurance, and other required credentials.
• Monitor provider credential expirations and proactively initiate renewal and recredentialing activities.
• Follow up directly with providers and applicants to obtain missing, incomplete, or expired documentation.
• Maintain accurate and up-to-date provider credentialing records and electronic files.
• Track application status, deadlines, turnaround times, and service-level expectations.
• Ensure provider files are organized and prepared for internal review and approval.
• Support credentialing audits, regulatory reviews, accreditation activities, corrective action plans, and special projects.
• Monitor and document compliance with applicable credentialing policies and regulatory requirements.
• Maintain working knowledge of applicable healthcare accreditation and regulatory standards.
• Support delegated credentialing and network management activities when applicable.
• Review provider data and credentialing records to identify discrepancies, compliance risks, or areas for improvement.
• Maintain accurate information across credentialing databases, Salesforce, legacy systems, and other assigned platforms.
• Respond to provider, client, and internal stakeholder inquiries regarding credentialing status and requirements.
• Prepare credentialing-related communications, notifications, and documentation as required.
• Participate in process improvement initiatives designed to improve quality, compliance, efficiency, and turnaround times.
• Assist with training, onboarding, and mentoring of less experienced team members when needed.
• Handle escalated or complex credentialing cases using independent judgment and appropriate escalation channels.
• Maintain confidentiality when handling sensitive provider and healthcare information.

• 5+ years of progressive experience in provider credentialing, healthcare enrollment, medical staff services, provider data management, or a closely related healthcare function.
• Strong experience with initial credentialing and recredentialing.
• Hands-on experience with Primary Source Verification (PSV).
• Knowledge of provider licensing, certifications, registrations, professional liability insurance, and credential expiration processes.
• Knowledge of healthcare accreditation and regulatory standards such as NCQA, URAC, CMS, and applicable state and federal requirements.
• Experience supporting credentialing audits, compliance reviews, or accreditation activities.
• Experience working with credentialing databases and healthcare information systems.
• Experience with Salesforce or similar systems is a plus.
• Strong analytical and problem-solving skills.
• Excellent attention to detail and documentation skills.
• Strong organizational and time-management skills.
• Ability to manage multiple providers, applications, deadlines, and projects simultaneously.
• Strong written and verbal communication skills.
• Ability to communicate professionally with healthcare providers, clients, and internal stakeholders.
• Ability to work independently and exercise sound judgment when handling complex cases.
• Strong Microsoft Office skills, particularly Excel,…