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Provider Credentialing Jobs (NOW HIRING)

West Virginia University Health System

Coordinates the transition of all relevant provider credentials, licenses, degrees, privileges, and certifications upon signing of a new provider. Operational ownership of the centralized ...

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Provider Credentialing information

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How much do provider credentialing jobs pay per hour?

As of Jul 10, 2026, the average hourly pay for provider credentialing 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 provider credentialing?

Provider credentialing is the process by which healthcare organizations verify and assess the qualifications, experience, and professional background of medical providers, such as doctors, nurses, and specialists. This includes checking education, training, licenses, certifications, work history, and any malpractice or disciplinary actions. Credentialing ensures that providers meet the standards required to deliver care and are eligible for participation in health insurance networks. It is a critical step for patient safety and regulatory compliance. The process must be repeated periodically to maintain up-to-date records and ensure ongoing eligibility.

What are some common challenges faced in a Provider Credentialing role, and how can they be managed?

A common challenge in Provider Credentialing is managing multiple deadlines and ensuring all documentation is accurate and up to date for various healthcare providers. The process often involves coordinating with providers, insurance companies, and regulatory bodies, which can lead to delays if communication is not clear. Staying organized, maintaining detailed records, and using credentialing management software can help streamline workflow and reduce errors. Building strong relationships with providers and team members also aids in resolving issues quickly and efficiently.

What is the difference between Provider Credentialing vs Medical Billing Specialist?

AspectProvider CredentialingMedical Billing Specialist
Required CredentialsLicenses, certifications, provider credentialsBilling certifications, coding knowledge
Work EnvironmentHealthcare facilities, insurance companiesMedical offices, billing companies
Employer & Industry UsageHospitals, clinics, insurance providersMedical practices, billing firms
Search & Comparison IntentUnderstanding credentialing process, requirementsBilling procedures, coding, reimbursement

Provider Credentialing focuses on verifying healthcare providers' qualifications to ensure they meet industry standards, while Medical Billing Specialists handle coding, billing, and reimbursement processes. Both roles are essential in healthcare operations but serve different functions within the industry.

What are the key skills and qualifications needed to thrive in Provider Credentialing, and why are they important?

To thrive in Provider Credentialing, you need strong attention to detail, organizational skills, and knowledge of healthcare regulations, typically supported by a background in healthcare administration or related fields. Familiarity with credentialing software, databases, and compliance tools such as CAQH ProView and state licensure systems is essential. Exceptional communication, problem-solving, and time management skills help professionals interact with providers and manage complex documentation processes. These competencies ensure accurate provider verification, regulatory compliance, and efficient onboarding, which are critical for healthcare organizations.
More about Provider Credentialing jobs
What cities are hiring for Provider Credentialing jobs? Cities with the most Provider Credentialing job openings:
What are the most commonly searched types of Provider Credentialing jobs? The most popular types of Provider Credentialing jobs are:
What states have the most Provider Credentialing jobs? States with the most job openings for Provider Credentialing jobs include:
What job categories do people searching Provider Credentialing jobs look for? The top searched job categories for Provider Credentialing jobs are:
Provider Credentialing jobs near you

Provider Credentialing & Contracting Coordinator

Group Helth Cooperative

Madison, WI • On-site

Full-time

Posted 19 days ago

Job description

Group Health Cooperative of South Central Wisconsin. BETTER TOGETHER
Full-time- 40 hours
Hybrid role - In-office training followed by a mix of work-from-home days and office days (2-3 days on site at the Administration Building)
Candidate must live in the Madison, WI area and be able to work on-site as needed.
The Provider Credentialing & Contracting Coordinator is responsible for supporting provider contracting, credentialing, and administrative functions at Group Health Cooperative of South Central Wisconsin. The primary focus of this role is assisting in negotiating and maintaining provider contracts, serving as the main contact for provider inquiries, overseeing contract setup and auditing, analyzing contracts for potential renegotiation and training providers in the use of self-service tools for insurance administration activities. In addition to contracting responsibilities, the specialist assists with the credentialing and recredentialing processes and ensures compliance with NCQA standards for Delegated Credentialing Agreements. The Provider Contracting and Credentialing Specialist will work under the guidance of the Chief Strategy and Business Development Officer.
JOB SPECIFIC MINIMUM QUALIFICATIONS
  1. Associate's or Bachelor's degree in business, healthcare administration or a related field or an applicable combination of education and work experience required. Bachelor's Degree preferred.
  2. Must be able to understand contract language and provider payment methodologies.
  3. Credentialing certificate preferred but not required. As a condition of employment, incumbent may be required to obtain certification within a reasonable time period.
  4. Knowledge of or ability to learn National Committee for Quality Assurance (NCQA) and/or Joint Commission on Health Care Organizations (JCHCO) standards required.
  5. Knowledge of and familiarity with medical terminology preferred.
  6. Strong interpersonal and communications skills and the ability to work effectively with a wide range of constituencies in a diverse community required. Ability to be culturally sensitive and to work with diverse populations.
  7. Strong customer service skills and the ability to maintain an excellent rapport with providers and their staff
  8. Time management skills and flexibility to work on multiple projects/assignments simultaneously, with ability to change focus as business needs dictate. Willingness to assume diverse duties and challenges
  9. Knowledge of and proven proficiency in the use of Microsoft Office applications including Word, Outlook, Excel and PowerPoint is required. Knowledge of and/or ability to learn and use computer based applications/software such as electronic time and attendance systems. Ability to use the Internet to obtain information and conduct research.
  10. Ability to build and maintain relationships with internal and external partners.
  11. Excellent written and verbal communication and interpersonal skills. Ability to speak and listen in person and in virtual meetings.
  12. Ability to maintain patient, employee and proprietary confidentiality required. Knowledge of or ability to learn HIPAA requirements.
  13. Ability to pay attention to detail required.
  14. Ability to work comfortably and routinely as part of a team and to cooperate across organizational boundaries.
  15. Professional manner necessary to deal courteously and effectively with customers and external partners.
  16. Possession of a valid Wisconsin Driver license with a good driving record. Access to transportation and ability to travel.
  17. Ability to maintain patient confidentiality required. Knowledge of medical records and appropriate documentation requirements. Knowledge of HIPAA requirements.

The incumbent knows and abides by all Group Health Cooperative of South Central Wisconsin (GHC-SCW) organizational and departmental policies, sets personal standards and strives for high quality work in completing assignments, performs job duties in a timely manner, and represents the organization in a positive manner.The incumbent understands our Mission, Vision, and Common Values (stated below) and is committed to promote these values in behavior and attitude.
Our Mission Statement:
We partner with members and the communities we serve to maximize health and well-being.
Our Vision:
As a local, not-for-profit, member-owned Cooperative, we are the most trusted resource for lifelong health and well-being in the communities we serve.
Our Values:
  • We are a not-for-profit Cooperative
  • We are member-centered
  • We are equitable and inclusive
  • We are quality-driven
  • We are innovative
  • We are community involved

GHC-SCW is committed to fostering a caring and compassionate environment while ensuring that individual differences are valued. GHC-SCW is a quality driven cooperative built on collaboration, community involvement, innovation, and belonging. It is essential that all employees, members, and patients feel secure and welcome, that the opinions and contributions of all individuals are respected and that all voices are heard.
We believe:
Healthcare is a human right.
In treating all people with dignity and respect.
There is strength in diversity.
Equity celebrates our humanity.
We are better together.
Group Health Cooperative of South Central Wisconsin is proud to be an equal opportunity employer. GHC-SCW considers candidates regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, disability or veteran status.

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