Credentialing Specialist - Primary Care & Podiatry

Job Description

Job Description

About the Role

We're a growing multispecialty practice (Primary Care & Podiatry) seeking an experienced Credentialing Specialist to own provider credentialing and payer enrollment from start to finish — from onboarding and application submission through payer follow-up, approval, roster maintenance, and recredentialing.

You'll work closely with Administration, Billing/Revenue Cycle, HR, and Compliance to ensure every provider is credentialed, enrolled, and linked to the correct locations and tax entities — so providers can see patients and claims get paid correctly and on time.

What You'll Do

• Prepare, submit, and follow through on credentialing, recredentialing, and enrollment applications with Medicare (PECOS), Florida Medicaid, Medicare Advantage, Medicaid Managed Care, and commercial payers
• Maintain provider CAQH profiles, NPPES/NPI records, and payer portal information
• Coordinate the credentialing portion of new provider onboarding, starting payer enrollment as early as possible to minimize billing delays
• Track licenses, DEA certificates, malpractice coverage, board certifications, and expirations; perform primary-source verification and maintain audit-ready files
• Manage provider additions, terminations, demographic changes, and payer roster reconciliation
• Partner with Billing/Revenue Cycle to resolve credentialing-related claim denials (provider-not-enrolled, effective-date issues, incorrect group affiliation)
• Maintain a credentialing tracking system and provide regular status reports to leadership
• Identify new payer and network participation opportunities to expand patient access

What You Bring

• 2–3+ years of medical provider credentialing and payer enrollment experience
• Strong working knowledge of Medicare PECOS, NPPES/NPI, CAQH, and Florida Medicaid enrollment
• Familiarity with taxonomy codes, group/individual NPIs, TIN affiliations, reassignment, and payer effective dates
• Knowledge of NPDB, OIG/SAM exclusion screening, and licensure/DEA verification
• Experience with the South Florida/Palm Beach County payer market strongly preferred
• Multispecialty group, Primary Care, or Podiatry credentialing experience a plus
• AthenaOne/Athenahealth experience a plus
• Proficiency with Excel, Microsoft Office, payer portals, and credentialing databases

Who You Are

Extremely organized, detail-oriented, and persistent with payer follow-up. You manage multiple provider enrollments independently, catch credentialing problems before they become billing problems, and communicate clearly with payers, providers, and internal teams.

Why Join Us

You won't just process applications — you'll own a function that directly impacts provider readiness and practice revenue, with visibility to leadership and room to build processes as we grow.