Credentialing Specialist

We are seeking an experienced Credentialing Specialist to manage provider enrollment and credentialing processes. The ideal candidate has a strong understanding of healthcare payer requirements, exceptional organizational skills, and the ability to manage multiple enrollments while ensuring timely and accurate completion.

Requirements:

• Minimum 3 years of credentialing experience
• Strong knowledge of Medicare, Medicaid, and commercial payer enrollments
• Hands-on experience with CAQH, PECOS, and NPPES
• Excellent organizational, communication, and time management skills
• Ability to manage multiple enrollments and meet deadlines
• Experience working for a medical billing company is preferred

Key Responsibilities:

• Manage provider enrollments with Medicare, Medicaid, and commercial insurance payers
• Complete initial enrollments, revalidations, and recredentialing applications
• Maintain accurate provider profiles in CAQH, PECOS, NPPES, and payer portals
• Follow up with insurance carriers to ensure timely processing and approvals
• Track enrollment statuses and maintain detailed, accurate records
• Work directly with providers and clients to obtain required documentation
• Resolve enrollment issues, respond to payer requests, and ensure compliance with credentialing requirements
• Stay current on payer enrollment policies and credentialing regulations