Job Details

POSITION SUMMARY:

The Credentialing Specialist is responsible for managing the credentialing, recredentialing, licensing and payer enrollment processes for healthcare providers to ensure uninterrupted patient care and compliance with all regulatory requirements. This role requires meticulous attention to detail and the ability to work collaboratively with internal teams, providers, and payer representatives. As our business continues to grow, the scope of responsibilities may evolve to meet organizational needs.

This is a Full-Time TEMP to PERM position.

PRIMARY RESPONSIBILITIES:

• Accurately maintain and update provider credentialing and payer enrollment records in CAQH, PECOS, credentialing software, and other payer-specific systems across multiple states.
• Manage and monitor all aspects of the payer enrollment and re-enrollment process to ensure timely and successful participation with contracted insurance plans.
• Analyze provider credentialing and enrollment files for completeness, accuracy, and compliance; identify and resolve any discrepancies or deficiencies.
• Collaborate closely with internal teams (billing, contracting, operations, and clinical) to align credentialing and payer enrollment processes with organizational timelines.
• Develop and maintain positive working relationships with payer representatives, providers, and third-party organizations to expedite application processing and issue resolution.
• Serve as a resource for providers by responding to inquiries via phone, email, or internal communication channels in a timely and professional manner.
• Track application status, monitor expirables, and ensure compliance with federal, state, and payer-specific regulations.
• Assist with audits, special projects, and process improvement initiatives related to credentialing and payer enrollment.

MINIMUM REQUIREMENTS

• Experience: 2+ years in provider credentialing.
• Working knowledge of payer enrollment processes, timelines, and requirements for commercial and government insurance plans.
• Experience using credentialing/enrollment software (i.e., Modio, VerityStream, Cactus, MD-Staff) preferred.
• Strong organizational skills and ability to manage multiple applications and deadlines simultaneously.
• Proficiency with Microsoft Office Suite (Excel, Word, Outlook) and comfort navigating web-based portals.
• Demonstrated ability to maintain strict confidentiality and comply with HIPAA regulations.
• Ability to work independently and as a collaborative team member in a fast-paced, evolving environment.
• Experience managing collaborative practice agreements preferred.

The anticipated salary range for this role is $50K-$55K annualized. This remote position follows a location-based compensation structure. The posted salary range represents the potential pay range across the geographic markets. Actual compensation will be determined based on the candidate's experience, qualifications, and internal equity considerations, in accordance with applicable pay transparency laws.

Pay Range: $50,000 - $55,000 per year