Creentialing Specialist
Summary
Manages healthcare provider credentialing, payer enrollment, and compliance processes to ensure timely approvals and billing continuity for a multi-location healthcare organization.
We are seeking an experienced Credentialing Specialist to join our growing, multi-location healthcare organization. This is a key role responsible for managing all aspects of provider credentialing, payer enrollment, recredentialing, and ongoing credential maintenance.
The ideal candidate will be able to step in immediately, evaluate current credentialing practices, establish reliable processes, develop tracking systems, and independently manage provider applications through payer approval and enrollment.
The Credentialing Specialist will collaborate closely with Providers, Revenue Cycle, Billing, Human Resources, Finance, Compliance, and Operational Leadership to ensure timely provider enrollment, prevent interruptions in billing, and maintain compliance with payer and regulatory requirements.
This role is ideal for a proactive, highly organized professional who enjoys building structure, solving enrollment challenges, and improving processes within a growing healthcare organization.
Key Responsibilities
- Manage provider credentialing, recredentialing, and payer enrollment processes from start to finish.
- Complete and submit applications to commercial insurance payers, government programs, and managed care organizations.
- Maintain and update provider information in CAQH and payer portals.
- Manage NPI registration, taxonomy updates, and NPPES maintenance.
- Track credentialing and enrollment statuses to ensure timely approvals and renewals.
- Monitor provider licenses, certifications, malpractice insurance, and other credential expirations.
- Maintain accurate provider rosters and enrollment records.
- Identify and resolve enrollment issues, denials, and application delays.
- Develop and maintain credentialing tracking systems, workflows, and documentation procedures.
- Serve as a liaison between providers, payers, and internal departments.
- Ensure compliance with organizational policies, payer requirements, and regulatory standards.
Compensation: $22.00-$26.00 per hour, based on experience.
Apply today if you're an experienced credentialing professional ready to make an immediate impact in a growing healthcare organization.