Credentialing Specialist - Multiple locations

Trusted Medical, PLLC

About us

Trusted Medical, PLLC is the clinical care delivery affiliate of Edera (www.edera.com). We specialize in serving Veterans by reducing wait times for them to gain access to disability screens and separation health assessments required by the Veteran Affairs (VA) to receive benefits. Help serve those who have served us by joining our growing team!

In addition to our core work with the VA, Trusted Medical holds multiple government contracts nationwide, allowing our providers to also participate in occupational health services for their applicants and employees. This includes pre-employment screenings, fitness-for-duty evaluations, and other health assessments that support a wide range of government agencies.

Position Description

The ideal candidate will serve as a subject matter expert capable of bridging the gap between vendor technology and clinical operations. They must possess a strong understanding of the product's functionality and troubleshooting techniques, enabling them to validate system performance and identify issues. This includes evaluating current workflows, recognizing opportunities for optimization, and recommending improvements in either system design or operational processes. The candidate should have firsthand industry experience in Credentialing solutions and demonstrate deep familiarity with the application of electronic health records in that setting. They must work to resolve issues and change requests. They must be able to confidently lead discussions with diverse stakeholders, assess current-state workflows, and propose enhancements that consider both immediate needs and downstream impacts. Additionally, they should be adept at articulating changes to affected groups, integrating those insights into training content and communication strategies to support long-term success across future rollouts.

Applicants with VA and/or DoD experience are preferred, along with an active federal clearance or the ability to obtain one

Type of Employment: Full-time salaried and fully benefited position

Work Location/Travel: On-Site in a Trusted Medical Clinic - see locations below

Salary Range: $52,123 - 57,456 base salary, depending on experience and location. Competitive salary/pay, potential for bonuses. There are multiple factors that are considered in determining final pay for a position, including, but not limited to, relevant work experience, skills, certifications and competencies that align to the specified role, geographic location, education and certifications as well as contract provisions regarding labor categories that are specific to the position. The pay range for this position is highly competitive but dependent upon employment type (1099, contract, W2).

Role Reports to: Clinical Capability Lead

Direct Reports: This role has no direct reports.

Responsibilities:

• Manage end-to-end credentialing process including enrollment, initial credentialing, and re credentialing.
• Conduct primary source verification of credentials (licenses, DEA, board certifications, education, work history).
• Maintain accurate provider data in credentialing systems (e.g., CAQH, CredentialStream, PECOS, NPPES).
• Track expiration of licenses, credentials, malpractice insurance, CME, and renewals; manage recredentialing timelines.
• Submit credentialing/enrollment applications to payers and follow up until in network status confirmed.
• Ensure compliance with state/federal regulations, NCQA, TJC, CMS, and accrediting institutions.
• Assist in developing/improving internal credentialing policies and procedures.
• * Respond to information requests from regulatory agencies or public inquiries as required.

Knowledge and Skills Required:

• Deep knowledge of healthcare regulatory requirements, credentialing standards (NCQA, TJC, CMS), and payer credentialing rules.
• Strong attention to detail and analytical skills to review applications, detect discrepancies, and resolve credentialing issues.
• Exceptional organizational and time-management skills, able to manage high volumes independently.
• Excellent written and verbal communication skills.
• Research-savvy, able to verify documentation across diverse systems and sources.
• Flexible and adaptable to frequent travel, with no restrictions on mobility.

Education/Certification Required:

• Bachelor's degree in Health Information Management, Healthcare Administration, Business Administration, or a related field required.

Preferred - Education/Certification:

• CPCS (Certified Provider Credentialing Specialist) certification from NAMSS is highly preferred.

Experience Required:

• 3+ years in healthcare credentialing or provider enrollment (specialist or coordinator roles).
• VA and/or DoD credentialing experience is strongly preferred.
• Experience ensuring compliance with regulatory standards and interacting with payers or government entities.
• Proven ability to manage credentialing data and documentation systems effectively.
• Demonstrated expertise in streamlining credentialing processes with accelerated turnaround times, enabling candidates to onboard and begin work more quickly.
• Technical Skills Required

Technical Skills:

• Proficiency in MS Office suite; advanced Excel preferred.
• Familiarity with credentialing platforms: CAQH ProView, CredentialStream, PECOS, NPPES, NPDB queries.
• Experience using healthcare compliance databases and understanding of data entry best practices.

Trusted Medical Locations:

All applicants must be US citizens and process Top Secret clearance. Trusted Medical, PLLCparticipates in the E-Verify program. Trusted Medical, PLLCis a drug-free workplace.