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Credentialing Consultant Jobs (NOW HIRING)

Ztek Consulting INC

Credentialing Specialist

Phoenix, AZ · On-site

$20 - $25/hr

Credentialing Specialist Duration: 6-12 months Location: Remote Work Type: Rate: Pay range offered ... Website: www.ztekinc.com Ztek Consulting Inc is a minority- and woman-owned business enterprise ...

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How much do credentialing consultant jobs pay per hour?

As of Jul 13, 2026, the average hourly pay for credentialing consultant in the United States is $24.36, according to ZipRecruiter salary data. Most workers in this role earn between $19.23 and $27.64 per hour, depending on experience, location, and employer.

What is a credentialing consultant?

A credentialing consultant is a professional who helps healthcare providers, organizations, or professionals obtain and maintain necessary licenses, certifications, and credentials. They review application processes, ensure compliance with industry standards, and often work with credentialing databases and verification tools to streamline credentialing procedures.

What is the difference between Credentialing Consultant vs Credentialing Specialist?

AspectCredentialing ConsultantCredentialing Specialist
Required CredentialsCertifications in healthcare compliance, healthcare administration, or related fields; experience in credentialing processesCertifications in healthcare administration or credentialing; familiarity with credentialing software
Work EnvironmentConsulting firms, healthcare organizations, or as independent consultantsHospitals, clinics, insurance companies, or healthcare provider offices
Employer & Industry UsageUsed by organizations seeking external expertise or project-based supportUsed internally within healthcare facilities for ongoing credentialing tasks

While both roles focus on credentialing processes, Credentialing Consultants typically provide expert advice and project-based support externally, whereas Credentialing Specialists handle daily credentialing tasks within healthcare organizations. The roles overlap in required credentials and work environment but differ mainly in scope and employment setting.

Is credentialing a hard job?

Credentialing as a Credentialing Consultant involves detailed review of healthcare providers' qualifications, requiring strong attention to detail, organization, and knowledge of industry standards. The job can be challenging due to the complexity of verifying credentials and managing compliance deadlines, but it is manageable with experience and familiarity with credentialing software. It often requires certifications and the ability to handle multiple tasks efficiently.

What are some common challenges a Credentialing Consultant faces when onboarding new healthcare providers?

Credentialing Consultants often encounter challenges such as managing tight deadlines, gathering complex or incomplete documentation from providers, and keeping up with the evolving requirements of various insurance payers and regulatory bodies. Clear communication and organization are essential, as consultants must frequently coordinate among providers, healthcare organizations, and credentialing entities. Staying updated on changing industry standards and maintaining meticulous attention to detail help ensure a smooth onboarding process and compliance with all necessary regulations.

How much does a credentialing specialist make in the US?

A credentialing specialist in the US typically earns between $40,000 and $60,000 annually, depending on experience, location, and employer size. The role often requires attention to detail, familiarity with healthcare or licensing regulations, and proficiency with credentialing software.

What are Credentialing Consultants?

Credentialing Consultants are professionals who assist healthcare organizations and providers in verifying and maintaining the necessary credentials, licenses, and certifications required to provide medical services. They ensure compliance with regulatory standards and help navigate the complex credentialing process with insurance companies, hospitals, and other medical entities. Their role is crucial in preventing administrative delays, reducing risk, and supporting providers in maintaining up-to-date qualifications.

What degree do you need to be a credentialing specialist?

A credentialing specialist typically needs at least a high school diploma or equivalent; however, many employers prefer candidates with a bachelor's degree in healthcare administration, business, or a related field. Relevant skills include attention to detail, knowledge of healthcare regulations, and experience with credentialing software or databases.

What are the key skills and qualifications needed to thrive as a Credentialing Consultant, and why are they important?

To thrive as a Credentialing Consultant, you need a strong understanding of healthcare credentialing processes, regulatory requirements, and attention to detail, typically supported by a background in healthcare administration or related certification (such as CPCS or CPMSM). Familiarity with credentialing software, databases, and compliance management systems is essential. Excellent organizational skills, effective communication, and problem-solving abilities are crucial soft skills for managing complex documentation and liaising with multiple stakeholders. These competencies ensure accurate provider onboarding, regulatory compliance, and the smooth operation of healthcare organizations.
More about Credentialing Consultant jobs
What job categories do people searching Credentialing Consultant jobs look for? The top searched job categories for Credentialing Consultant jobs are:
Credentialing Consultant jobs near you
Infographic showing various Credentialing Consultant job openings in the United States as of July 2026, with employment types broken down into 2% Locum Tenens, 87% Full Time, 7% Part Time, and 4% Contract. Highlights an 89% Physical, 3% Hybrid, and 8% Remote job distribution, with an average salary of $50,665 per year, or $24.4 per hour.

Enrollment Provider & Credentialing Consultant

Solutions Technology, Inc / STI Health & Wellness

Odenton, MD • On-site

Contractor

Posted 19 days ago

Job description

Job Summary
This is an independent contractor role.  The Insurance Provider Enrollment and Credentialing Specialist manages the administrative process of enrolling healthcare providers into commercial and government health insurance networks. This role conducts comprehensive background verifications to ensure all clinical staff meet regulatory, licensing, and accreditation standards. This vital role ensures clinicians are legally permitted to practice, properly affiliated with commercial and governmental payers, and authorized to submit claims for patient care. The Specialist acts as the primary liaison between clinicians, medical billing teams, and health insurance payers to ensure uninterrupted reimbursement for patient care.
Salary Requirements
$49,700 - $59,300 ($23.89 - $28.51 per hour)
Contract Part-Time, Onsite
Core Responsibilities
  • Credential Verification: Verify provider medical licenses, board certifications, DEA registrations, education, and malpractice insurance.
  • ​​​​​Network Enrollment: Compile, complete, and submit detailed payer applications, track them to ensure completion, and resolve issues that prevent a provider from gaining "in-network" status with commercial insurance plans. Obtain and manage practice locations and provider rosters. Enroll individual clinicians and group practice in:
    • Tricare, BCBS CareFirst, AETNA, CIGNA, United Healthcare, and other commercial payers as needed
  • Database Maintenance: Update and maintain accurate provider profiles in national databases and registries including CAQH and NPPES.
  • Tracking & Follow-up: Monitor the status of pending applications with payers to ensure timely network approval and prevent credentialing gaps.  Respond to payer request for additional information.
  • Compliance Management: Ensure compliance with payer and regulatory requirements. Track expiration dates for provider licenses, certificates, and insurances to ensure continuous compliance. Maintain enrollment records and approval dates.
  • Re-Credentialing & Revalidation Cycle: Proactively update files and renew applications to maintain compliance with changing state, federal (CMS), and accrediting (NCQA/TJC) regulations.  Manage the routine re-credentialing and revalidation processes mandated by insurers and regulatory bodies.
  • Issue Resolution: Investigate and resolve enrollment delays, provider data errors, and credentialing-related billing rejections.
  • Cross-Department Collaboration: Partner with HR, legal, clinicians, and billing/coding to streamline provider onboarding.
  • Contract Coordination
    • Work with payer representatives during the contracting process
    • Ensure contracts are executed and effective dates are recorded
    • Track reimbursement schedules and network participation status
Key Qualifications:
  • Education: High school diploma or GED required; bachelor’s degree in healthcare administration or a related field preferred.
  • Experience: Minimum of 2–4 years of direct experience in medical credentialing and payer enrollment.
  • Systems Proficiency: Hands-on experience using CAQH ProView, NPPES, and electronic medical record (EMR) software.
  • Regulatory Knowledge: Deep understanding of NCQA and Joint Commission credentialing guidelines and compliance standards.
  • Skill Set: Exceptional attention to detail, strong organizational skills, and excellent written and verbal communication abilities.
Preferred Qualifications
  • Certification: Certified Provider Credentialing Specialist (CPCS) or Certified Professional Medical Services Management (CPMSM) designation.
  • Payer Network: Established relationships or familiarity with regional commercial health plan provider relations departments.

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