Credentialing Specialist

Job Description

Job DescriptionDescription:

We are seeking a detail-oriented Part-Time Credentialing Specialist to support our behavioral health programs by managing both provider and facility credentialing processes. This role ensures compliance with state and federal regulations, payer requirements, and accreditation standards. The ideal candidate understands the critical role credentialing plays in behavioral health service delivery and demonstrates exceptional organization and discretion. Key responsibilities of this position include:

Provider Credentialing

• Manage initial credentialing and re-credentialing for licensed and unlicensed behavioral health providers
• Maintain complete and accurate provider credentialing files in accordance with:
  • State licensing requirements
  • DHS and county contracting standards
  • Accreditation bodies (CARF, COA, etc., if applicable)
  • Payer and managed care organization requirements
• Conduct primary source verifications (licenses, education, certifications)
• Track licensure, certifications, trainings, background studies, and supervision documentation
• Prepare and submit payer enrollment and revalidation applications
• Monitor expiration dates and proactively communicate renewal requirements

Facility Credentialing

• Manage facility credentialing and re-credentialing with payers and regulatory bodies
• Maintain facility licensure, certifications, and compliance documentation
• Track facility-level requirements including:
  • Licenses and permits
  • Accreditation status
  • Inspections and site visit documentation
• Prepare and submit facility enrollment and revalidation applications
• Coordinate with leadership on site visits, audits, and payer reviews
• Ensure facility records remain current and audit-ready

General Compliance Duties

• Ensure compliance with HIPAA and data privacy standards
• Support internal and external audits and site visits
• Maintain credentialing databases and tracking systems
• Collaborate with HR, Clinical Leadership, QA, and Compliance teams
• Identify opportunities to improve credentialing workflows and tracking systems

Requirements:

• Associate’s degree or equivalent experience preferred
• Experience in healthcare or behavioral health credentialing preferred
• Knowledge of:
  • State licensing boards
  • Behavioral health regulatory requirements
  • Payer enrollment processes
• Strong attention to detail and documentation accuracy
• Ability to manage competing deadlines
• Excellent communication skills
• Proficiency in Microsoft Office and credentialing systems
• Experience with CAQH, NPI registry, and payer portals preferred
• Ability to handle PHI and confidential data professionally

Compensation

In compliance with Minnesota pay transparency requirements, this position has a good faith hourly wage range of $22.00 – $27.00 per hour. Starting pay is determined based on experience, education, job-related skills, and internal equity.

Benefits

Eligible part-time employees may have access to benefits in accordance with organizational policy.