Credentialing Specialist

Join Affiliated Oncologists as a Credentialing Specialist!

AO specializes in treating a variety of cancers including lymphoma lung, breast, prostate, gynecologic, colorectal and head and neck cancers. Our physicians and staff are multi-disciplinary team of highly experienced caregivers focused on helping patients and their families receive the best care and support possible.

SCOPE: Under general supervision, oversees, maintains and coordinates actions for physician credentialing, licensure and hospital privileges activities. Supports and adheres to the US Oncology Compliance Program, to include the Code of Ethics and Business Standards. The Credentialing Specialist is responsible for the complete lifecycle of provider and entity credentialing and payer enrollment across a multispecialty oncology practice. This role ensures providers are accurately credentialed, recredentialed, and enrolled with commercial, Medicare, Medicaid, and specialty oncology payer programs to enable timely reimbursement and compliant patient access. In addition, the role provides structured administrative support to team leads and management (e.g., meeting logistics, tracking deliverables, reporting) to keep operational initiatives on schedule. This role collaborates closely with Revenue Cycle, Provider Onboarding, Compliance, Medical Staff Services, Contracting, and Payer Relations to reduce delays, prevent denials, and maintain continuous payer participation.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

Credentialing & Enrollment (Primary)

• Endtoend provider/entity credentialing: Collect, verify, and maintain credentials for physicians, advanced practice providers (APPs), pharmacists, infusion RNs (as applicable), and practice entities (group, locations, lab, radiation, etc.).
• Payer enrollment & reenrollment: Prepare and submit enrollment applications (commercial payers, Medicare PECOS, Medicaid, specialty oncology programs); manage effective dates; track approvals.
• Primary Source Verification (PSV): Validate licensure, DEA, CSR, board certifications, NPDB queries, OIG/SAM exclusions, malpractice history, hospital affiliations, and CAQH profiles.
• CAQH & PECOS management: Create/maintain provider profiles; ensure data integrity; manage reattestations and digital signatures.
• Taxonomy & NPI management: Coordinate Type 1/Type 2 NPIs; taxonomy codes; ensure alignment with contracts and billing requirements.
• Location & roster maintenance: Keep payer rosters current (adds, terms, specialties, locations, telehealth flags); submit updates promptly.
• Recredentialing cycles: Maintain calendars for deadlines; initiate recredentialing packets and PSV in advance; avoid lapses.
• Contract alignment: Partner with Contracting/Payer Relations to ensure credentialed specialties and locations match executed agreements and fee schedules.
• Denial prevention: Collaborate with Revenue Cycle to resolve "provider not enrolled/credentialed" denials; implement corrective actions and upstream fixes.
• Audit & compliance: Maintain documentation for internal/external audits (e.g., NCQA/URAC elements if applicable, Medicare/Medicaid participation requirements).
• Data integrity: Maintain credentialing database/worklists; update EHR/practice management systems and clearinghouse where applicable.

Administrative Support to Team Leads & Management (Secondary)

• Meeting & workflow coordination: Schedule meetings, prepare agendas, capture minutes/action items, track deliverables, and followups.
• Reporting & dashboards: Produce weekly/monthly status reports (e.g., application aging, effective dates, PSV completion, payer approvals); distribute to stakeholders.
• Document management: Organize shared drives, credentialing files, SOPs, templates, and version control; manage esignature workflows.
• Intake & communication: Triage requests (provider additions, changes, terminations); maintain communication templates; provide updates to providers and internal teams.
• Process improvement: Assist in SOP updates, checklists, and training materials; identify bottlenecks and propose solutions.
• Vendor & portal support: Maintain portal access (CAQH, PECOS, Medicaid, payer sites); coordinate with IT for rolebased access; troubleshoot login issues.
• Special projects: Support network strategy initiatives, payer roster reconciliations, location openings/closures, and integration activities for new service lines.

MINIMUM QUALIFICATIONS:

• Experience: 2-4 years in healthcare credentialing/payer enrollment (multispecialty or oncology preferred); central business office experience a plus.
• Knowledge: Working knowledge of CAQH, PECOS, Medicare/Medicaid enrollment, commercial payer portals, NPDB, OIG/SAM checks, taxonomy/NPI rules.
• Systems: Proficiency with credentialing systems, practice management/EHR, Excel, and shared document repositories.
• Compliance: Familiarity with industry standards, CMS regulations, state licensure rules, and payer participation requirements.
• Communication: Strong written/verbal skills; ability to interface professionally with providers and payer representatives.
• Organization: High attention to detail, deadlinedriven, able to manage multiple applications and timelines simultaneously.

Preferred Qualifications

• Prior oncology practice experience (medical, radiation, surgical oncology).
• Experience supporting revenue cycle or payer contracting teams.
• Certification (e.g., CPCS or CPMSM) or equivalent credentialing coursework.
• Experience with large payer enrollments (multistate) and roster management.

Core Competencies

• Detail Orientation & Accuracy - zerodefect mindset for data entry and documentation.
• Time Management & Prioritization - manages competing deadlines across many payers/providers.
• Problem Solving - anticipates issues (effective dates, taxonomy mismatches) and proposes fixes.
• Collaboration - works crossfunctionally with Rev Cycle, Compliance, Onboarding, and Operations.
• Discretion & Professionalism - handles sensitive provider information securely and respectfully.
• Continuous Improvement - seeks automation and standardization opportunities.

Key Performance Indicators (KPIs)

• Average days from complete packet to payer approval (by payer type).
• % of recredentialings submitted 60 days before deadline.
• Denials due to credentialing/enrollment issues (rate and trend).
• Roster accuracy (variance vs. payer confirmation; audit scores).
• Application aging (number >30/60/90 days).
• Turnaround for provider adds/changes/terms (cycle times).
• Provider satisfaction (survey scores on communication and clarity).

Reporting Structure

• Reports to: Revenue Cycle Manager (or Credentialing Manager, if applicable).
• Partners with: Provider Onboarding, Compliance, Payer Relations/Contracting, Medical Staff Services, Finance.
• May provide task guidance to credentialing coordinators or interns.

Tools & Systems

• Credentialing platform
• CAQH ProView, Medicare PECOS, Medicaid portals, commercial payer portals.
• Practice Management/EHR, clearinghouse (for NPI/taxonomy configuration).
• Microsoft 365 (Excel, Teams, SharePoint), esignature tools.

PHYSICAL DEMANDS: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is regularly required to sit and use hands to finger, handle, or feel. The employee is occasionally required to stand, walk, and reach with hands and arms. The employee must occasionally lift and/or move up to 30 pounds. Requires vision and hearing corrected to normal ranges.

WORK ENVIRONMENT: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Work is performed in an office environment and requires frequent interaction with physicians, staff and hospital credentialing departments.

HOURLY RANGE:

• $21.00 - $35.00

BENEFITS OFFERED:

• Medical

• Healthcare Reimbursement Accounts (HRCA)

• Health Savings Accounts (HAS)

• Dental

• Vision

• Life Insurance

• Short-Term Disability (STD)

• Long-Term Disability (LTD)

• Employee Assistance Program (EAP)

• Commuter Benefits

• 401(k)

• Wellness Program

Applicants will be hired into the title appropriate to their credentials and years of experience.