Credentialing Specialist

The Credentialing Specialist is responsible for managing the credentialing and re-credentialing process for licensed therapists — including Speech-Language Pathologists (SLPs), Occupational Therapists (OTs), and Physical Therapists (PTs) — ensuring compliance with regulatory, accreditation, and organizational standards. This role verifies provider qualifications, licenses, certifications, and work history to support patient safety, risk management, and payer enrollment requirements.

• High school diploma or equivalent required; associate or bachelor’s degree preferred
• 2+ years of experience in credentialing, healthcare administration, or a therapy/rehab services setting
• Familiarity with credentialing software and databases
• Strong understanding of credentialing standards (NCQA, URAC, Joint Commission) and therapy-specific licensure/certification bodies (state PT/OT/SLP boards, ASHA, NBCOT, FSBPT)
• Excellent organizational skills and high attention to detail
• Strong written and verbal communication skills
• Ability to manage multiple priorities and meet deadlines
• Proficiency in Microsoft Office (Excel, Word, Outlook)

• Certified Provider Credentialing Specialist (CPCS) certification
• Experience with payer enrollment processes for rehab/therapy services
• Experience credentialing across multiple states (for multi-state or telehealth practices)
• Knowledge of HIPAA and healthcare compliance regulations

• →Process initial credentialing and re-credentialing applications for speech, occupational, and physical therapists
• →Perform primary source verification of state licenses, national certifications (e.g., ASHA CCC-SLP, NBCOT, NPTE), education, clinical training, malpractice history, and work references
• →Maintain accurate and up-to-date provider files in credentialing software/databases (e.g., CAQH, Symplr, MD-Staff)
• →Track and manage expiration dates for licenses, certifications, CEUs, and liability insurance coverage; proactively initiate renewal processes
• →Coordinate with clinical operations, insurance payers, and facility/agency partners to complete enrollment and privileging
• →Ensure compliance with NCQA, URAC, Joint Commission, CMS, state licensing boards, and payer-specific requirements
• →Prepare credentialing files and reports for internal review and audits
• →Communicate with therapists to obtain missing documentation or clarify discrepancies
• →Respond to inquiries from internal departments, payers, and external agencies regarding credentialing status
• →Maintain confidentiality of sensitive provider information in accordance with HIPAA
• →Assist with internal and external audits related to credentialing compliance
• →Monitor state-specific licensure requirements across multiple jurisdictions if supporting multi-state practice or telehealth therapy services

• Office-based, hybrid, or fully remote depending on organization
• May require occasional overtime during audit periods or high-volume credentialing cycles