Credentialing Specialist

Job Description

Job Description

Description:

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.

Full-Time | Available In the Philadelphia, PA 19133 Area

Salary:

$22.00/HR

Scheduled:

Monday-Friday 8:30am-5:00pm

Job Summary

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.

Essential Duties and 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.

Employees are eligible for generous benefit options including but not limited to:

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.

Credentialing Specialist Job 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.

About COMHAR:

COMHAR is a nonprofit human-services organization dedicated to empowering individuals, families, and communities to live healthier, self-determined lives. Our mission is: “To provide health and human services that empower individuals, families and communities to live healthier, self-determined lives.” Serving the Philadelphia region since 1975, COMHAR provides a wide continuum of behavioral health, intellectual and developmental disability, substance use, and social support services. With programs that include outpatient treatment, residential services, community-based recovery centers, supportive housing, and specialized services for children, families, and diverse populations, COMHAR delivers person-centered care rooted in dignity, respect, and community integration. Today, COMHAR’s team supports more than 5,500 people each month, helping individuals build stability, independence, and meaningful connections in their communities. COMHAR strictly follows a zero-tolerance policy for abuse.

COMHAR is proud to be an Equal Opportunity Employer. We maintain a drug-free workplace. COMHAR, Inc. is a not-for-profit community-based health and human service organization founded in 1975. We do not discriminate in services or employment on the basis of race, color, religion, ancestry, national origin, sex, sexual orientation, gender identity, age, disability, past or present receipt of disability-related services or supports, marital status, veteran status, or any other class of persons protected by federal, state or local law.