Job Description Credentialing Specialist

Position: Credentialing Specialist

Job Summary

We are seeking a detail-oriented and experienced *Credentialing Specialist* to manage provider credentialing, recredentialing, payer enrollment, and related activities. The ideal candidate should have experience working with *US healthcare insurance payers* and provider enrollment processes.

Key Responsibilities

* Manage initial credentialing and recredentialing for physicians, therapists, and other healthcare providers.

* Complete and submit provider applications to *Medicare, Medicaid, and commercial insurance payers*.

* Maintain provider information in CAQH and other payer portals.

* Follow up with insurance payers regarding application status, missing documents, and approvals.

* Track credentialing and recredentialing timelines to ensure timely submissions.

* Manage provider enrollment, additions, terminations, and demographic updates.

* Maintain accurate credentialing files, provider records, licenses, certifications, and other required documents.

* Coordinate with providers and internal teams to obtain required documentation.

* Work with payer portals and systems such as CAQH, Availity, Medicare, Medicaid, and commercial payer websites.

* Prepare and maintain credentialing status reports and trackers.

* Identify and resolve credentialing-related issues, delays, and denials.

* Ensure compliance with payer, state, federal, and organizational requirements.

Required Qualifications

* Minimum *2–5 years of experience in US healthcare provider credentialing and payer enrollment*.

* Strong knowledge of Medicare, Medicaid, and commercial payer credentialing processes.

* Experience with CAQH and payer portals.

* Understanding of provider enrollment, revalidation, recredentialing, and contracting processes.

* Excellent communication and follow-up skills.

* Strong attention to detail and organizational skills.

* Ability to manage multiple providers and applications simultaneously.

* Proficiency in Microsoft Excel and other reporting tools.

Preferred Qualifications

* Experience in behavioral health or multi-specialty credentialing.

* Experience working with multiple state Medicaid programs.

* Knowledge of NPI, taxonomy, PECOS, and provider enrollment requirements.

* Experience working with RCM or medical billing organizations.

Employment Type

*Full-Time*

Skills

Credentialing | Provider Enrollment | CAQH | Medicare | Medicaid | Commercial Payors | Recredentialing | Payer Portals | Healthcare RCM