Credentialing and Enrollment Specialist

Credentialing And Enrollment Specialist (Medallion Platform)

Senior Psych Care provides fully integrative behavioral health services to the long-term care patient, at their facility.

The Credentialing and Enrollment Specialist is responsible for managing provider credentialing, re-credentialing, and payer enrollment processes using the Medallion credentialing platform. This role ensures that healthcare providers are properly credentialed and enrolled with insurance networks in a timely and compliant manner.

Key Responsibilities:

• Manage end-to-end provider credentialing and re-credentialing processes using the Medallion platform
• Coordinate and process provider enrollment applications with commercial and government payers (e.g., Medicare, Medicaid, and private insurers)
• Maintain accurate and up-to-date provider records within Medallion and internal systems
• Track application status, follow up with payers, and resolve delays or discrepancies
• Ensure compliance with regulatory standards, payer requirements, and organizational policies
• Verify provider credentials including licenses, certifications, malpractice insurance, and work history
• Prepare and submit credentialing packets and enrollment applications
• Communicate with providers to obtain required documentation and updates
• Monitor expiration dates and initiate recredentialing cycles proactively
• Generate reports and maintain audit-ready documentation
• Collaborate with internal departments such as billing, compliance, and HR

Required Qualifications:

• High school diploma or equivalent (Associate's or Bachelor's degree preferred)
• 2+ years of experience in provider credentialing and enrollment
• Hands-on experience with the Medallion credentialing platform (strongly preferred)
• Knowledge of payer enrollment processes, CAQH, and healthcare regulations
• Familiarity with Medicare, Medicaid, and commercial insurance requirements
• Strong attention to detail and organizational skills
• Excellent communication and follow-up skills
• Ability to manage multiple tasks and meet deadlines

Preferred Qualifications:

• Certification such as CPCS (Certified Provider Credentialing Specialist) or CPMSM
• Experience working in a healthcare organization, medical group, or managed care environment
• Experience with credentialing audits and compliance standards (e.g., NCQA, Joint Commission)

Key Skills:

• Proficiency in Medallion platform and credentialing tools
• Data entry and record management accuracy
• Problem-solving and issue resolution
• Time management and prioritization
• Customer service and provider relations

Work Environment:

• Office-based
• Fast-paced healthcare administrative setting

What We Offer:

• Competitive salary, commensurate with experience
• Comprehensive benefits package including:
• Medical
• Dental
• Vision
• Short and Long Term Disability
• Life Insurance
• 401 (k)
• Paid Time Off and Paid Holidays