Provider Credentialing Specialist

About the role

The Provider Credentialing Specialist works closely with the Provider Team, Call Center Specialists, and other NationsBenefits employees to manage the credentialing lifecycle for healthcare providers. This position requires strong interpersonal skills, attention to detail, and the ability to handle multiple tasks while maintaining accurate records.

Key responsibilities

• Communicate inbound and outbound with providers to address credentialing questions, concerns, and complaints.
• Maintain and update electronic and hard‑copy credentialing files, ensuring completeness and accuracy.
• Process, record, and track credentialing documents in systems and shared spreadsheets.
• Monitor incoming provider data (faxes, files) and follow up for missing information.
• Prepare and distribute credentialing approval letters and take minutes at monthly Credentialing Committee meetings.

Required profile

• Bachelor’s degree in Computer Science, IT, or related field, or equivalent experience.
• 3+ years of experience in healthcare credentialing and data/analytics engineering.
• Strong problem‑solving abilities, professional demeanor, and ability to work under pressure.
• Willingness to work occasional evenings, weekends, or holidays as needed.

Required skills

• Proficiency in SQL and Python.
• Experience with data warehousing concepts and ETL processes.
• Familiarity with data visualization tools.
• Basic to intermediate knowledge of Microsoft Excel and other Microsoft applications.