Credentialing Specialist

Credentialing Specialist

Recognized as a "Best Place to Work Modern Healthcare" – Join a team where people come first. At Vital Care, we are committed to creating an inclusive, growth-focused environment where every voice matters. Vital Care is the premier pharmacy franchise business with franchises serving a wide range of patients, including those with chronic and acute conditions. Since 1986, our passion has been improving the lives of patients and healthcare professionals through locally-owned franchise locations across the United States. We have over 100 franchised Infusion pharmacies and clinics in 35 states, focusing on the underserved and secondary markets. We know infusion services, and we guide owners along the path of launch, growth, and successful business operations.

What We Offer:

• Comprehensive medical, dental, and vision plans, plus flexible spending, and health savings accounts.
• Paid time off, personal days, and company-paid holidays.
• Paid Paternal Leave.
• Volunteerism Days off.
• Income protection programs include company-sponsored basic life insurance and long-term disability insurance, as well as employee-paid voluntary life, accident, critical illness, and short-term disability insurance.
• 401(k) matching and tuition reimbursement.
• Employee assistance programs include mental health, financial and legal.
• Rewards programs offered by our medical carrier.
• Professional development and growth opportunities.
• Employee Referral Program.

Job Summary

The Credentialing Specialist is responsible for supporting the full lifecycle of payer enrollment and credentialing activities across Medicare, Medicaid, commercial, and pharmacy enrollments, as applicable, including the timely and accurate preparation, submission, and follow up of enrollment applications, revalidation, and recredentialing requirements. This role serves as a key liaison between the organization and its franchise network, providing credentialing guidance and support to franchisees while coordinating with internal teams to facilitate enrollment activities. The position requires strong organization, accuracy, and accountability to manage multiple enrollments and ensure timely completion of all credentialing processes.

Job Duties/Responsibilities

• Execute the full lifecycle of payer enrollment and credentialing activities across Medicare, Medicaid, commercial, PBM, and pharmacy enrollments, as applicable, including initial applications, revalidations, recredentialing, and ongoing maintenance.
• Prepare, review, and submit enrollment applications and supporting documentation, ensuring accuracy and completeness to minimize delays or rejections.
• Monitor and track the status of all enrollment activities using designated tracking tools and systems, maintaining accurate and up to date records.
• Conduct proactive follow up on pending applications, revalidations, and recredentialing requirements, including responding to payer requests for additional information.
• Serve as the internal point of contact for credentialing activities and as a liaison to franchisees, providing guidance on enrollment requirements and next steps.
• Manage and respond to inquiries received through the credentialing shared inbox, including triaging and routing requests as appropriate.
• Maintain franchise records, including licenses, accreditations, insurance, and related documentation, ensuring all credentialing records are current.
• Identify upcoming expirations, revalidations, and renewal requirements and communicate proactively with franchisees.
• Process and submit updates related to changes in franchise or clinic information, including address, ownership, tax identification number, and banking information.
• Complete NPI and NCPDP applications, updates, and maintenance activities as required.
• Monitor high priority enrollment matters, including applications and credentialing items, and provide escalation support as needed.
• Identify issues, delays, or potential risks encountered during enrollment and credentialing activities and escalate to the Credentialing Manager in a timely manner.
• Coordinate with internal departments, including Legal & Compliance, RCM, Operations, and other stakeholders, to obtain required information and ensure alignment.
• Maintain organized and complete documentation of all enrollment activities in designated systems.
• Assist with audits, reporting, and data requests related to credentialing and payer enrollment activities.
• Support cross training efforts and assist with different enrollment types based on workload and business needs.
• Participate in training and educational opportunities as identified by leadership to maintain knowledge of credentialing requirements and processes.
• Perform other duties and special projects as assigned.

Required Skills/Abilities

• Strong knowledge of payer enrollment and credentialing processes across Medicare, Medicaid, commercial, PBM, and pharmacy enrollments, as applicable.
• Experience preparing and submitting enrollment applications, including revalidations, recredentialing, and change requests through applicable enrollment systems.
• Working knowledge of credentialing-related systems and tools, including the ability to track and manage enrollment activities using internal systems.
• Strong attention to detail with the ability to review applications and supporting documentation for accuracy, completeness, and compliance with payer requirements.
• Ability to manage multiple tasks and prioritize competing deadlines in a fast-paced environment while maintaining accuracy and timeliness.
• Ability to identify issues, delays, or risks within credentialing activities and escalate appropriately in a timely manner.
• Strong organizational skills with the ability to maintain accurate, complete, and well-documented records across multiple systems.
• Strong verbal and written communication skills, with the ability to effectively communicate with franchisees and internal stakeholders.
• Demonstrated ability to provide a high level of customer service to franchisees, including guiding them through credentialing requirements and processes.
• Ability to work collaboratively across departments and function effectively as part of a team.
• Self-motivated with the ability to work independently with minimal supervision while maintaining accountability for assigned responsibilities.
• Ability to adapt to changing priorities and support multiple enrollment types based on business needs.
• Demonstrated computer skills (Excel, Microsoft Office, PowerPoint, and Word).
• Willingness to participate in training and ongoing education to maintain knowledge of credentialing requirements and industry practices.

Education and Experience

• High school diploma required. Bachelor's degree in Business, Health Services, Business Administration, or related field preferred.
• Minimum of three (3) years of experience supporting payer enrollment and credentialing activities, including initial enrollments, revalidations, recredentialing, and maintenance of provider information.
• Experience within a healthcare or pharmacy-related environment preferred.
• Equivalent combination of education and relevant experience may be considered.

Physical Requirements

• Sitting: Prolonged periods of sitting are typical, often for the majority of the workday.
• Keyboarding: Frequent use of a keyboard for typing and data entry.
• Reaching: Occasionally reaching for items such as files, documents, or office supplies.
• Fine Motor Skills: Precise movements of the fingers and hands for tasks like typing, using a mouse, and handling paperwork.
• Visual Acuity: Good vision for reading documents, computer screens, and other detailed work.

Be part of an organization that invests in you! We are reviewing applications for this role and will contact qualified candidates for interviews. Vital Care Infusion Services is an equal-opportunity employer and values diversity at our company. We do not discriminate on the basis of color, race, sex, age, religion, national origin, disability, genetic information, gender identity, sexual orientation, veterans' status, or any other basis protected by applicable federal, state, or local law. Vital Care Infusion Services participates in E-Verify. This position is full-time. The salary range for this position is $56,318 - $75,255.