Medical Insurance Credentialing Lead

Job Description

Job Description

Amazing Opportunity! Live & work near Disney with Medinex Healthcare Solutions! (Remote/Hybrid work)

Job Summary

The Medical Insurance Credentialing Lead will play a foundational role in designing, launching, and leading the organization’s new credentialing and payer enrollment function. This individual will serve as the subject-matter expert for all credentialing operations, responsible for building workflows, managing payer enrollments, ensuring compliance, and developing a scalable service offering.

In addition to performing hands-on credentialing work, this role will establish processes, tools, and quality standards and will hire and oversee a Credentialing Assistant as volume grows. The ideal candidate has deep credentialing expertise, enjoys building programs from the ground up, and is comfortable operating in both strategic and hands-on capacities.

Key Responsibilities

Program & Service Line Development

• Design and implement the organization’s credentialing and re-credentialing program from the ground up
• Develop credentialing workflows, tracking tools, turnaround standards, and standard operating procedures (SOPs)
• Partner with leadership to support the launch of credentialing as a formal internal and external service offering
• Establish scalable processes to support future growth, new practices, and expanded service demand

Credentialing & Enrollment Operations

• Manage the full lifecycle of provider credentialing and re-credentialing for physicians and advanced practice providers
• Prepare, submit, track, and follow up on enrollment applications with Medicare, Medicaid, and commercial payers
• Maintain complete, accurate, and compliant provider credentialing files, including licenses, certifications, malpractice insurance, and payer documentation
• Ensure timely updates and attestations in CAQH ProView, PECOS, NPPES, and payer-specific portals
• Track credentialing timelines, expirations, and renewals to prevent billing delays or network participation gaps

Leadership & Oversight

• Serve as the primary credentialing resource and escalation point for internal teams and external physician partners
• Hire, train, and supervise a Credentialing Assistant as volume increases
• Perform quality checks and internal audits to ensure adherence to payer requirements, NCQA standards, and regulatory guidelines
• Create reporting and metrics related to credentialing turnaround times, payer approval rates, and revenue impact

Revenue Cycle & Compliance Collaboration

• Work closely with billing and RCM teams to ensure credentialing status aligns seamlessly with claims workflows
• Support new provider onboarding, practice start-ups, expansions, and network participation optimization
• Monitor payer policy changes and Florida-specific regulatory updates, recommending and implementing process improvements
• Contribute credentialing expertise to overall revenue optimization and compliance initiatives

Qualifications & Preferences

Required

• 4+ years of progressive medical insurance credentialing experience
• Demonstrated success managing Medicare, Medicaid, and major commercial payer enrollments
• Strong working knowledge of CAQH ProView, PECOS, NPPES, and payer enrollment platforms
• Experience managing multiple providers and practices concurrently
• Exceptional organizational skills and attention to detail
• Strong written and verbal communication skills with payers, providers, and internal stakeholders
• Ability to work independently and take ownership of building new operational functions

Preferred

• Experience within an RCM, MSO, or multi-practice physician organization
• Prior experience launching or formalizing credentialing workflows or programs
• Bachelor’s degree in Healthcare Administration, Business, or related field
• CPCS or CPMSM certification strongly preferred
• Prior experience training or supervising credentialing staff
• Knowledge of Florida healthcare and payer regulations

What We Offer

• Competitive compensation with leadership and growth opportunity
• Comprehensive benefits package including medical, dental, vision, 401(k) with company match, and paid time off
• Flexible hybrid or remote work options
• Professional development support, including certification reimbursement
• Opportunity to build and lead a critical new service line from the ground up
• Collaborative culture focused on accountability, quality, and continuous improvement

Join Us

If you are a credentialing professional who thrives in building programs, improving processes, and supporting physician success, we invite you to apply and help us launch our credentialing service.