Credentialing Specialist

Credentialing Specialist

At Birdi, we understand that accurate credentialing and provider enrollment are critical to ensuring patients have access to care, providers can participate in payer networks, and the organization remains compliant with regulatory and accreditation requirements.

We're looking for a highly organized and detail-oriented professional who enjoys managing complex processes, building strong relationships, and ensuring accuracy in a fast-paced healthcare environment. If you thrive on keeping things organized, solving problems, and driving processes to completion, we'd love to hear from you.

Credentialing & Recredentialing

• Coordinate and administer initial credentialing and recredentialing activities for healthcare providers.
• Collect, verify, and maintain provider documentation, including professional licenses, certifications, registrations, education records, training documentation, and employment history.
• Conduct primary source verification in accordance with organizational policies and accreditation standards.
• Monitor credential expiration dates and proactively manage renewal activities.
• Prepare credentialing files for committee and leadership review.
• Maintain accurate provider records within credentialing databases and document management systems.

Provider Enrollment & Payer Relations

• Process provider enrollment, revalidation, and updates with commercial and government payers.
• Prepare and submit enrollment applications and required supporting documentation.
• Track application progress and proactively follow up with health plans, PBMs, and government agencies.
• Resolve enrollment delays, discrepancies, and participation issues.
• Maintain strong working relationships with payer and network representatives.
• Communicate application status and enrollment updates to internal stakeholders.

Compliance & Regulatory Support

• Ensure credentialing activities comply with NCQA requirements, CMS requirements, URAC standards, state and federal regulations, and organizational policies and procedures.
• Conduct regular audits of credentialing files to ensure completeness and accuracy.
• Support accreditation reviews and regulatory audits.
• Maintain strict confidentiality of provider and organizational information.
• Assist with documentation requests and audit preparation activities.

Provider & Internal Support

• Serve as a primary point of contact for providers regarding credentialing and enrollment activities.
• Communicate documentation requirements, deadlines, and application status updates.
• Collaborate with Human Resources, Compliance, Legal, Operations, and Pharmacy Leadership.
• Provide exceptional customer service to both internal and external stakeholders.
• Answer inquiries regarding credentialing requirements and enrollment processes.

Reporting & Process Improvement

• Generate credentialing and enrollment status reports.
• Monitor workflow performance and identify opportunities for improvement.
• Analyze credentialing and enrollment issues and recommend solutions.
• Support the development and maintenance of credentialing policies, procedures, and best practices.
• Participate in department projects and process improvement initiatives.

Required Qualifications

Education

• High School Diploma or GED required.
• Associate's degree in Business, Healthcare Administration, or a related field preferred.
• Equivalent combinations of education and relevant experience may be considered.

Experience

• Minimum of 2 years of experience working with credentialing, provider enrollment, contracting applications, government payer enrollment, health plan credentialing, PBM enrollment processes.
• Administrative, document-processing, or data-entry experience within healthcare, pharmacy, insurance, regulated business environments.

Knowledge, Skills & Abilities

• Strong organizational skills with the ability to manage multiple priorities simultaneously.
• Excellent attention to detail and commitment to accuracy.
• Strong interpersonal and communication skills.
• Ability to work collaboratively with stakeholders at all levels of the organization.
• Ability to interpret credentialing requirements and resolve enrollment challenges.
• Strong analytical and problem-solving abilities.
• Ability to identify discrepancies and determine appropriate corrective actions.
• Strong judgment and ability to maintain confidentiality.
• Ability to work independently while managing deadlines and competing priorities.
• Comfortable learning and utilizing credentialing systems, databases, and software applications.
• Proficiency with Microsoft Outlook, Microsoft Word, Microsoft Excel.
• Willingness to work occasional extended hours during peak credentialing and recredentialing periods.

Preferred Qualifications

• Experience with provider credentialing, pharmacy credentialing, payer enrollment, Medicaid enrollment, PBM enrollment processes.
• Familiarity with credentialing software and provider management systems.
• Experience supporting accreditation and compliance initiatives.
• Knowledge of pharmacy network enrollment and managed care requirements.

Key Competencies

• Credentialing Administration
• Provider Enrollment
• Regulatory Compliance
• Attention to Detail
• Relationship Management
• Process Coordination
• Documentation Management
• Audit Readiness
• Problem Solving
• Organizational Skills
• Customer Service
• Communication & Follow-Through

Work Environment

• Remote/home-office environment.
• Occasional local and overnight travel may be required.
• Minimal exposure to excessive noise or adverse environmental conditions.
• Travel may include automobile and air transportation.
• Ability to sit for prolonged periods of time.
• Frequent computer and document-processing activities throughout the workday.

Why This Role Matters

Credentialing is one of the most important functions supporting provider participation, patient access, and organizational compliance. The Credentialing Specialist helps ensure providers are accurately credentialed, enrolled, and maintained within payer networks while supporting accreditation and regulatory requirements.

Your attention to detail, organizational skills, and ability to navigate complex enrollment processes will directly contribute to operational efficiency, provider satisfaction, and Birdi's continued growth and success.

Equal Employment Opportunity Statement

Birdi is an Equal Opportunity Employer and is committed to fostering an inclusive and diverse workplace. We make employment decisions without regard to race, color, religion, creed, sex, gender, sexual orientation, gender identity or expression, national origin, age, disability, protected veteran status, marital status, genetic information, or any other characteristic protected by applicable federal, state, or local laws.

Birdi is committed to providing reasonable accommodations to qualified individuals with disabilities throughout the recruitment process and employment relationship. If you require an accommodation, please notify a member of our Talent Acquisition team.