Credentialing Specialist

About the role

We are a growing physician-owned pain management group operating multiple clinic locations and an ambulatory surgery center. We need an experienced credentialing professional to own the full provider credentialing lifecycle — not a generalist VA who will learn credentialing on the job.

This is a detail-heavy, follow-up-driven role. Applications sit in payer queues for months, licenses expire quietly, and a single missing signature can hold up an entire enrollment. The person who succeeds here is relentless about chasing paperwork and keeps meticulous records without being asked.

What you'll do

Primary source verification and background screening

• Verify state medical licenses, DEA registrations, and controlled substance registrations directly with issuing boards
• Run and document NPDB queries, OIG/LEIE and ---------- exclusion checks, and board certification verification (ABMS/AOA)
• Verify education, training, and complete employment history — including obtaining written explanations for any gaps
• Coordinate criminal background checks, drug screens, and reference/peer review letters
• Confirm malpractice claims history and maintain current certificates of insurance

Credentialing and enrollment

• Prepare, submit, and track initial credentialing and re-credentialing applications
• Maintain CAQH ProView profiles, including quarterly attestations and document re-uploads
• Manage Medicare (PECOS), Medicaid/AHCCCS, and commercial payer enrollments, revalidations, and demographic updates
• Maintain accurate NPPES/NPI records, group affiliations, and payer rosters across all locations
• Track application status weekly and escalate stalled files with documented follow-up

Ambulatory surgery center support

• Build and maintain medical staff credentialing files for the ASC, including initial appointment and biennial reappointment packets
• Ensure files meet accreditation and Medicare Conditions for Coverage standards (AAAHC, Joint Commission, or AAAASF)
• Prepare credentialing packets for medical executive committee and governing body review
• Maintain privilege delineation forms and current privilege rosters

Expirables and data integrity

• Maintain a master expirables tracker (licenses, DEA, BLS/ACLS, COI, board certification, attestations) with advance reminders at 120/90/60/30 days
• Keep provider demographic information consistent across all payers, directories, the practice management system, and internal rosters
• Produce a weekly status report showing what's pending, what's blocked, and what's expiring

Follow-up

• Call and email payers, licensing boards, prior employers, and schools to chase outstanding items
• Follow up with our own providers to collect signatures, documents, and responses
• Log every contact — date, person, reference number, outcome, next step

Requirements

• 2+ years of hands-on US provider credentialing experience (please state the number of providers you have credentialed and for what type of organization)
• Direct experience credentialing at or for an ambulatory surgery center — this is required, not preferred
• Working knowledge of CAQH, PECOS, NPPES, and at least one payer portal (Availity, Navinet, or similar)
• Familiarity with credentialing software (Modio, Verifiable, MD-Staff, IntelliSoft, Symplr, or comparable)
• Excellent written and spoken English — you will be on the phone with US payers and licensing boards
• HIPAA training and a signed confidentiality/business associate agreement
• Strong, quiet home office: reliable computer, minimum 25 Mbps internet, backup internet, backup power (UPS or generator), noise-cancelling headset
• Comfortable working independently with weekly check-ins rather than daily supervision

Nice to have

• CPCS or CPMSM certification
• Experience with Arizona payers (AHCCCS, BCBSAZ, Banner, Health Net Access, Mercy Care)
• Experience with pain management, anesthesia, or surgical specialty credentialing
• Experience building a credentialing tracker from scratch

How to apply

Applications that don't follow these instructions won't be reviewed.

1. Start your message with the word PRIVILEGES so we know you read the posting.
2. In 3–5 sentences, describe the most difficult credentialing file you've worked on and how you resolved it.
3. Tell us: how many providers have you credentialed, at what type of facility, and which credentialing software you used.
4. List your available hours in Arizona time and your monthly rate expectation.
5. Attach or link your resume.

Shortlisted candidates will complete a brief paid skills exercise (reviewing a sample provider file and identifying what's missing or expired) and a video interview.