Senior Credentialing Specialist

Senior Credentialing Specialist

Healthcare Coding & Consulting Services (HCCS) is seeking an experienced Senior Credentialing Specialist to join our growing team. This is a fully remote, full-time opportunity for a highly organized credentialing professional with extensive experience managing provider enrollment, credentialing, and payer relationships across multiple healthcare organizations.

At HCCS, we are committed to providing long-term career stability in a collaborative, family-owned environment. Every member of our team is a direct-hire W-2 employee who plays an important role in supporting the healthcare organizations we serve. We proudly keep our operations within the United States and are dedicated to delivering exceptional service through experienced professionals.

If you have advanced knowledge of provider credentialing, enrollment, EDI, and payer requirements, thrive in a fast-paced environment, and enjoy solving complex credentialing challenges, we encourage you to apply.

Position Requirements

• Minimum of three (3) years of provider credentialing and payer enrollment experience in a healthcare setting.
• High school diploma or equivalent required; Associate's or Bachelor's degree in Healthcare Administration, Business Administration, or a related field preferred.
• Extensive experience with Medicare, Medicaid, and Commercial Insurance credentialing and provider enrollment.
• Strong understanding of NCQA, CMS, Joint Commission, and payer credentialing requirements.
• Experience managing Electronic Data Interchange (EDI) enrollment and maintenance.
• Advanced proficiency in Microsoft Excel, including formulas, data analysis, sorting/filtering, pivot tables, and reporting.
• Experience using Modio, CAQH, and other credentialing or provider enrollment platforms.
• Excellent organizational, communication, analytical, and problem-solving skills.
• Ability to manage multiple priorities, meet deadlines, and work independently in a remote environment.

Position Responsibilities

• Manage all aspects of provider credentialing, recredentialing, and enrollment for multiple healthcare organizations and providers.
• Prepare, submit, and track Medicare, Medicaid, and Commercial Insurance enrollment applications.
• Coordinate provider enrollment, revalidation, recredentialing, and demographic updates with government and commercial payers.
• Manage EDI enrollment, including electronic claims, ERA, EFT, and payer connectivity.
• Verify provider licensure, certifications, education, malpractice coverage, work history, DEA registrations, and other required documentation.
• Maintain accurate provider records within Modio, CAQH, and other credentialing databases.
• Monitor credential expiration dates and proactively coordinate renewals to ensure uninterrupted provider participation.
• Communicate with providers, payers, facilities, and internal stakeholders to resolve credentialing and enrollment issues.
• Generate reports, analyze credentialing data, and utilize advanced Excel functions to track provider status, enrollment metrics, and compliance.
• Ensure compliance with NCQA, CMS, Joint Commission, payer, and organizational standards.
• Identify opportunities to improve credentialing workflows and support process improvements.

Preferred Qualifications

• Certified Provider Credentialing Specialist (CPCS) certification.
• Certified Professional Medical Services Management (CPMS) certification.
• Experience credentialing providers across multiple healthcare organizations or multi-site health systems.
• Experience supporting provider enrollment projects, system implementations, or process improvement initiatives.

Why Join HCCS?

• Fully remote, full-time position
• Direct-hire W-2 employment
• Competitive compensation
• Medical, dental, and vision insurance
• 401(k)
• Paid Time Off (PTO)
• Supportive, collaborative team environment
• Long-term career stability with a family-owned company

Schedule

Full-time

Work Location

Remote (United States)