Credentialing Specialist

Job Description

Job Description

We are looking for a detail-oriented Credentialing Specialist to support provider enrollment activities for a 2-3 month contract position based in Columbus, Ohio. In this role, you will oversee credentialing, payer enrollment, and ongoing provider data maintenance to help ensure timely participation in Medicare and commercial insurance networks. You will work closely with internal teams, providers, and payer contacts to keep records current, address application issues, and support uninterrupted reimbursement.

Responsibilities:

• Oversee the preparation and submission of provider enrollment materials for Medicare and commercial payers, including initial applications, renewals, and revalidation requests.

• Track credentialing and enrollment cases through completion, following up with insurance carriers and managed care organizations to address missing items or processing delays.

• Maintain provider participation records by updating demographic details, practice locations, benefit assignments, status changes, and terminations as needed.

• Monitor key due dates for recredentialing cycles, payer renewals, and Medicare revalidation requirements to help prevent lapses in network participation.

• Investigate and resolve enrollment-related concerns that could interfere with claims adjudication, billing accuracy, or reimbursement timing.

• Communicate application progress, effective dates, and payer participation updates to stakeholders across billing, revenue cycle, human resources, and clinical leadership.

• Organize and maintain accurate credentialing documentation, enrollment files, and audit-ready records in accordance with payer and organizational standards.

• Partner with external payer representatives and internal departments to ensure provider information is complete, compliant, and submitted within required timelines.

• Contribute to reporting, audit preparation, and continuous improvement efforts related to credentialing workflows and enrollment processes.

• Hands-on experience in provider credentialing, physician credentialing, and payer enrollment administration.
• Working knowledge of Medicare enrollment procedures, revalidation requirements, and commercial insurance credentialing standards.
• Ability to manage initial applications, recredentialing activities, and provider data updates with strong attention to accuracy.
• Experience monitoring application status, coordinating follow-up, and resolving discrepancies with payer organizations.
• Familiarity with provider enrollment documentation, effective date tracking, and participation record maintenance.
• Strong organizational and communication skills with the ability to collaborate across operational and clinical teams.
• Ability to support audits, reporting needs, and compliance-related reviews within credentialing functions.