Director Credentialing Verification Office Jobs

A5 Healthcare (Anders Affiliate) one of the fastest-growing Credentialing Verification Organizations in the country is seeking a Credentialing Specialist who is motivated to learn, excited to collaborate and passionate about delivering outstanding results. This individual will have a direct impact on our firm's mission of serving as a catalyst for those striving to achieve their highest potential. 

The Credentialing Specialist for the Credentials Verification Organization (CVO) at A5 Services is responsible for managing and verifying credentialing applications for initial appointments and reappointments across multiple facilities. This role involves thorough data analysis, primary source verification, and the monitoring of expiring provider documents to ensure compliance with regulatory and accreditation standards. The Specialist plays a key part in supporting credentialing workflows, maintaining turnaround times, and communicating effectively with internal staff, providers, and external organizations.

This role requires discretion, strong documentation and analytical skills, and the ability to handle confidential and complex credentialing tasks while exemplifying a high standard of professionalism and customer service.

What You'll Do: 

Credentialing Operations

• Perform comprehensive application management, including requesting, receiving, processing, and verifying initial and reappointment applications.
• Conduct preliminary analysis of application data and verification information to identify any red flags or adverse findings.
• Monitor expiring provider data such as professional licenses, DEA registrations, board certifications, and malpractice insurance.
• Communicate timely updates to providers and member organizations regarding application status and outstanding requirements.
• Prepare credentialing files accurately and submit them for facility audits and approvals in accordance with turnaround standards.
• Maintain working knowledge of relevant accreditation and regulatory standards (TJC, AAAHC, DNV, NCQA, and CMS).
• Assist with continuous improvement of credentialing workflows, including process alignment and development of forms.
• Participate in special projects and team initiatives as assigned.

General Responsibilities

• Maintain credentialing documentation and records with accuracy and confidentiality.
• Follow organizational policies and escalate issues beyond scope as needed.
• Collaborate effectively with CVO leadership and credentialing team members.
• Attend training sessions and professional development meetings to stay current with industry best practices.

Competencies

• Decision Making: Uses general instructions and established practices to make decisions; may recommend improvements to moderately complex issues.
• Problem Solving: Analyzes and interprets varied situations to resolve credentialing issues based on industry knowledge and precedent.
• Independence of Action: Follows established policies, organizes work effectively, and seeks guidance for complex or unusual scenarios.
• Written & Oral Communications: Communicates clearly with providers and facilities; able to explain credentialing requirements effectively.
• Knowledge Application: Demonstrates working knowledge of credentialing procedures and applies them accurately in day-to-day tasks.
• Team Collaboration: Engages in teamwork to support department objectives, share knowledge, and contribute to continuous improvement.

What We're Looking For: 

• Strong documentation and analytical skills with high attention to detail.
• Ability to interpret and apply credentialing standards and regulatory guidelines.
• Excellent verbal and written communication skills.
• Proven ability to organize, prioritize, and manage multiple responsibilities.
• Ability to work independently and in a team-based remote environment.
• Sound problem-solving and decision-making capabilities.
• Commitment to confidentiality and professional ethics.

Your Qualifications: 

• High school diploma or GED required.
• 1-3 years of relevant credentialing experience, preferably within a CVO or similar setting.
• Proficiency with Microsoft Office applications (Word, Excel, Outlook) and web-based systems.
• Knowledge of credentialing software platforms and auditing processes preferred.

Applicants to the Credentialing Specialist position must be located within the Greater St. Louis, MO area.