Provider Credentialing Specialist (Org Wide)

The Provider Credentialing Specialist develops and maintains a network of high-quality, culturally competent service providers to meet members' needs through establishing contracts and ensuring regulatory compliance. This role involves monitoring provider credentials, negotiating rates, finalizing contracts, and maintaining electronic records to substantiate credentialing and contract compliance. The specialist also supports providers with contract interpretation, provides education on program requirements, and participates in the External Quality Review process.