Credentialing Specialist

Job Summary The Credentialing Specialist is responsible for managing the end-to-end provider credentialing and enrollment process with insurance payers. The role ensures that healthcare providers are properly credentialed, enrolled, and re-credentialed to maintain uninterrupted revenue flow and compliance with payer and regulatory requirements. Key Responsibilities 1. Provider Enrollment & Credentialing Handle end-to-end credentialing process for physicians and healthcare providers. Prepare and submit provider enrollment applications to insurance payers. Complete CAQH registration, updates, and attestations. Ensure timely submission of new enrollments, re-credentialing, and updates. 2. Follow-ups & Payer Communication Communicate with insurance companies to track application status. Follow up on pending, rejected, or incomplete applications. Resolve enrollment-related issues with payers. 3. Documentation & Compliance Collect and verify provider documents (licenses, DEA, board certification, malpractice insurance, NPI, etc.). Maintain accurate and updated provider records. Ensure compliance with payer and regulatory guidelines. 4. Re-Credentialing & Maintenance Track re-credentialing timelines and renewal dates. Maintain a credentialing database and monitoring system. Ensure no lapse in provider participation with payers. 5. Reporting & Coordination Maintain credentialing trackers and MIS reports. Coordinate with billing, AR, and operations teams for smooth provider activation. Support audits related to credentialing documentation. Required Qualifications 1-3+ years of experience in provider credentialing (US Healthcare preferred). Strong knowledge of CAQH, NPI, PECOS, and insurance payer portals. Familiarity with Medicare, Medicaid, and commercial payer enrollment. Good communication and follow-up skills. Attention to detail and ability to meet deadlines. Preferred Skills Experience in RCM / Medical Billing company. Knowledge of HIPAA compliance. Ability to manage multiple providers simultaneously. Strong organizational and documentation skills. #J-18808-Ljbffr