Credentialing Specialist

COMHAR INC • Philadelphia, PA

19h • $22 • Onsite

About The Position

We are seeking a highly organized and detail-oriented Credentialing Specialist to join our team. This role is responsible for managing and maintaining accurate staff credentialing files to ensure compliance with regulatory, accreditation, and organizational requirements. The Credentialing Specialist will oversee documentation collection, verification of licenses and certifications, tracking of expiration dates, and ongoing file maintenance. The ideal candidate is proactive, efficient, and thrives in a fast-paced environment where accuracy and communication are key.

The Credentialing Specialist is responsible for ensuring that COMHAR, Inc.’s employees, contractors, and service providers meet all credentialing, re-credentialing, and privileging requirements in accordance with Community Behavioral Health (CBH) standards, Pennsylvania Code, Medicaid and Medicare regulations, and other applicable managed care and funding source requirements. This position supports CBH delegated credentialing compliance by developing, implementing, and maintaining effective credentialing processes that ensure audit readiness and regulatory compliance.

Requirements

• A minimum of a High School diploma or GED.
• At least 2 years of related credentialing experience in health care or human services.
• Knowledge and understanding of full cycle credentialing and re-credentialing procedures.
• Knowledge of Medicaid, Medicare and Managed Care organizations.
• Working knowledge of clinical operations and procedures.
• Database management skills including querying, reporting, and document generation.

Responsibilities

• Develops, implements, and maintains credentialing and re-credentialing processes in compliance with delegated credentialing requirements, contractual obligations, and regulatory standards.
• Coordinates and monitors initial credentialing, re-credentialing, and ongoing monitoring for all employees, contractors, and licensed behavioral health professionals.
• Conducts primary source verification of professional licenses, certifications, education, training, and work history in accordance with COMHAR, CBH standards, state, federal, payer, and accreditation requirements.
• Reviews internal behavioral health practitioner applications and supporting documentation to determine eligibility, completeness, and compliance.
• Initiates and manages provider credentialing and privilege for licensed behavioral health professionals based on funding source requirements.
• Tracks credential expiration dates and ensure timely renewal to prevent lapses in compliance or service delivery.
• Identifies credentialing discrepancies, compliance risks, or missing documentation and ensures timely investigation, resolution, and documentation.
• Prepares and maintains up-to-date credentialing files for CBH site reviews, delegated credentialing audits, and regulatory inspections.
• Conducts routine internal credentialing file audits and supports the development and implementation of corrective action plans when needed.
• Responds to credential inquiries from internal departments, managed care organizations, and regulatory entities.
• Assists with verification of pre-employment credentials, including licensure, certifications, education, degrees, background checks, and required clearances.
• Maintains strict confidentiality of credentialing records in accordance with HIPAA regulations.
• Establishes and maintains a credentialing audit schedule for all programs to ensure continuous compliance.
• Manages accurate timely data and document entry in credentialing and HRIS systems.
• Generates monthly credentialing compliance reports for leadership review and regulatory oversight.
• Travels to COMHAR locations as needed to support credentialing activities and audit preparation.
• Performs other related duties as assigned to support organizational compliance and quality assurance efforts.

Benefits

• Full-time and Part-time employees enjoy a comprehensive benefits package including medical, vision, and dental insurance, life and disability coverage, a 403(b) retirement plan, paid time off, tuition reimbursement, an employee assistance program, and additional voluntary options such as disability, accident, and pet insurance.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED