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Provider Credentialing information

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$38

How much do provider credentialing jobs pay per hour?

As of Aug 21, 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 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.

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.

How to get into provider credentialing?

To enter provider credentialing, candidates typically need a background in healthcare administration, medical billing, or related fields, along with strong organizational and communication skills. Gaining certification such as the Certified Provider Credentialing Specialist (CPCS) can enhance job prospects. Familiarity with healthcare regulations and credentialing software is also beneficial.

Is provider credentialing hard?

Provider credentialing can be a complex process that involves verifying a healthcare professional’s qualifications, licenses, and work history, often requiring attention to detail and organization. It typically involves working with multiple organizations and adhering to specific regulations, which can make the process time-consuming and challenging for some providers. Strong communication skills and familiarity with credentialing software can help streamline the process.

What does a provider credentialing specialist do?

A provider credentialing specialist is responsible for verifying healthcare providers' qualifications, licenses, and certifications to ensure they meet the standards required by insurance companies and healthcare organizations. They manage the credentialing process, maintain accurate provider records, and ensure compliance with regulatory requirements, often using specialized credentialing software. This role requires attention to detail, knowledge of healthcare regulations, and strong organizational skills.
More about Provider Credentialing jobs

What cities are hiring for Provider Credentialing jobs?

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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
Infographic showing various Provider Credentialing job openings in the United States as of August 2026, with employment types broken down into 3% As Needed, 76% Full Time, 15% Part Time, and 6% Contract. Highlights an 93% Physical, 2% Hybrid, and 5% Remote job distribution, with an average salary of $50,665 per year, or $24.4 per hour.

Provider Enrollment & Credentialing Coordinator

Orthopaedic Solutions Management

Tampa, FL • On-site

Full-time

Re-posted 12 days ago

Job description

Job Summary:

The Provider Enrollment & Credentialing Coordinator is responsible for all aspects of provider enrollment, credentialing, recredentialing, and privileging processes for employed and contracted practitioners. This includes maintaining accurate provider data in credentialing databases, ensuring timely submission and renewal of required documentation and supporting compliance standards. The Coordinator will work closely with providers, payers, and internal departments to ensure practitioners are appropriately credentialed and enrolled to support timely patient access and reimbursement.

Responsibilities:

  • Coordinate initial credentialing and recredentialing for physicians, physician assistants, and advanced practice providers across Medicare, Medicaid, commercial insurers, and delegated payers.
  • Obtain and maintain NPI provider numbers utilizing the PECOS, Medicaid, Availity and NPPES websites.
  • Prepare Credentialing files for FOI Credentialing Committee. This would include completing all required primary source verifications.
  • Track and maintain provider insurance participation status and effective dates in Athena.
  • Maintain timely and accurate data entry in credentialing databases and payer portals; update provider rosters and profiles as needed.
  • Process facility privilege applications and reappointments of privileges.
  • Monitor and manage expirable documents (licenses, DEA, board certifications, malpractice insurance), alerting providers and escalating unresolved expirations to the Manager.
  • Submit and update provider information in the CAQH ProView system as required by participating health plans.
  • Ensure compliance with NCQA, URAC, CMS, and payer requirements for provider credentialing and enrollment.
  • Assist with issue resolution and communication with payers regarding credentialing/enrollment status and delays.
  • Upload and track CME documentation in relevant databases (e.g., CE Broker).
  • Communicate credentialing or enrollment issues and application delays to the Manager in a timely manner.
  • Participate in internal audits, special projects, and process improvements as directed.
  • Perform other duties as assigned by department leadership.

Education And Experience:

  • Healthcare administration, business, or a related field preferred.
  • Minimum 2 years of experience in provider credentialing or enrollment, preferably in a healthcare, medical group, or managed care environment.
  • Working knowledge of:
  • Credentialing standards (NCQA, URAC, CMS)
  • Credentialing software and payer enrollment systems
  • Proficiency in Microsoft Excel and Office Suite; comfort with electronic databases and file management systems.
  • Strong attention to detail, organization, and ability to manage multiple tasks and deadlines.
  • Effective verbal and written communication skills, especially in provider-facing interactions.
  • Ability to handle sensitive data with a high level of confidentiality and accuracy.

Prefferred Qualifications & Skills

  • Prior experience with delegated credentialing or payer audit support
  • Experience using Athenahealth and VerityStream platforms
  • Basic understanding of medical terminology and healthcare regulations
  • CPCS (Certified Provider Credentialing Specialist) certification preferred but not required

Orthopaedic Solutions Management is a Drug Free Workplace

We are committed to maintaining a safe, healthy, and productive work environment. As part of this commitment, we operate as a drug-free workplace. All candidates will be required to undergo pre-employment drug screening and/or be subject to random drug testing in accordance with applicable laws and company policy.