Credentialing Specialist

Position Overview

We are seeking an experienced Credentialing Specialist to manage provider credentialing, recredentialing, and payer enrollment. This role ensures compliance with regulatory and insurance requirements while supporting timely provider onboarding and uninterrupted reimbursement.

Responsibilities

• Credentialing & Recredentialing: Manage the full-cycle credentialing and recredentialing process.

• Applications & Verification: Complete and submit credentialing and payer enrollment applications, and verify provider licenses, DEA registrations, certifications, education, and work history.

• Payer Enrollment: Enroll providers with Medicare, Medicaid, and commercial insurance payers.

• Documentation & Compliance: Maintain accurate credentialing files, monitor expirations, and ensure ongoing compliance with regulatory and insurance requirements.

• CAQH Management: Maintain provider CAQH profiles and ensure timely attestations.

• Application Tracking: Track applications, follow up with insurance carriers, and monitor progress to ensure timely completion.

• Workflow Management: Use Monday.com to track workflows, deadlines, and provider onboarding.

Qualifications

• Minimum of 2 years of credentialing and payer enrollment experience.

• Experience with Medicare, Medicaid, and commercial insurance.

• Proficiency in CAQH, PECOS, and payer portals.

• Strong organizational and multitasking skills.

• Ability to work independently with minimal training.