Credentialing & Licensing Specialist

Salary Range: 22.37 to 33.56 (Currency: USD) (Pay period: per-hour-wage)

Essential Functions

• Complete, monitor and follow-up as needed, provider credentialing and recredentialing applications with all commercial, Medicaid, Medicare, and Medicaid managed care payers
• Provide all payers with demographic updates when providers are added or terminated
• Create, update, and maintain CAQH Provider data base accounts for clinicians, physician assistants and physicians.  Acquire accounts for new providers (APRNs, PAs and physicians) not previously registered with CAQH
• Obtain, update, and maintain the National Plan and Provider Enumeration System (NPPES) / Provider Enrollment, Chain and Ownership System (PECOS) accounts for all APRNs, PAs and physicians
• Maintain electronic copies current state licenses, Board certification, DEA registration and CSR (LA only) certificates, malpractice coverage and any other required credentialing documents for all providers
• Apply for malpractice coverage for new providers (APRNs, PAs and physicians), including off-site emergency coverage for physicians. Annually review the malpractice coverage for all providers with Affiliate Risk and Quality Management or designee
• Develop and maintain instructions for current health plans and federal/state agency requirements for credentialing providers in each health plan or program
•  Maintain electronic folder of signed physician contracts including archived contracts
• Manage and maintain confidentiality of provider information, including corporate related information needed for federal/state agencies
• Creates and promotes a culture of continuous improvement
• Ensures compliance with all CHN and affiliate policies, as well as all state and federal regulations
• Demonstrates a commitment to CHN and Planned Parenthood’s mission related to health equity, especially centering racial equity, and deep sense of accountability to community
• Demonstrates a commitment to learning about and enhancing practices related to racial equity and the impact of structural racism on healthcare systems
• Provides positive and development feedback and accountability related to practices including, but not limited to, equity


The above duties and responsibilities are not an exhaustive list of required responsibilities, duties, and skills. Other duties may be added, and this job description can be amended at anytime.

Qualifications and Experience (Required)

• Bachelor’s degree and three years of related experience with credentialing providers in a medical practice, with the accompanying knowledge and understanding of the credentialing process with health insurance plans and use of CAQH, or the equivalent combination of education, training, and related experience
• Strong analytical and problem-solving abilities
• Proficiency with Microsoft software (Excel, etc.)
• Must be able to create and edit fillable forms in Adobe Acrobat
• Ability to handle highly confidential and sensitive matters and documents
• Ability to define problems, collect data, establish facts and draw valid conclusions
• Ability to interpret an extensive variety of technical instruction in mathematical or diagram form and deal with several abstract and concrete variables
• Knowledge of business practices and protocols
• Ability to demonstrate initiative and to work with minimal direction
• Demonstrated ability to maintain a customer-centric service approach in a fast-paced environment
• Excellent written and verbal communication skills and ability to collaborate and interact with all levels within and outside of CHN if necessary
• Strong attention to detail and follow-up; and ability to multi-task in fast-paced environment
• Demonstrated dedication to Planned Parenthood’s mission, vision, and values
• Strong interpersonal skills and the ability to build relationships with stakeholders
• Excellent time management, and problem-solving skills

Qualifications and Experience (Preferred)

• Certified Provider Credentialing Specialist Certification (CPCS)
• Experience working with state Medicaid programs is highly desirable
• Strong working knowledge of professional billing software applications
• Two to Five years billing office experience
• One year’s data reporting experience

Key Requirements

• Commitment to advancing race(+) equity in one’s work: interested in expanding knowledge about the role that racial inequity plays in our society
• Awareness of multiple group identities and their dynamics, bringing a high level of self-awareness about personal identity, empathy, and humility to interpersonal interactions
• Demonstrated ability to communicate clearly and directly as well as hear and act on feedback related to identity and equity with the aim to learn
• Strong sense of accountability to equitable practices
• Understanding of the impact of identity dynamics on organizational culture
• Commitment to CHN and Planned Parenthood’s In This Together service ethos, workplace values, and service standards