Credentialing & Enrollment Specialist

Join a mission-driven nonprofit healthcare organization and help ensure providers are credentialed, enrolled, and ready to serve the Albuquerque community.

About the role

The Credentialing & Enrollment Specialist will coordinate provider credentialing, recredentialing, and payer enrollment activities to ensure healthcare providers remain properly credentialed and eligible to provide and bill for services. This position requires exceptional attention to detail, organization, follow-through, and the ability to manage multiple provider files and deadlines simultaneously.

Responsibilities

• Coordinate initial credentialing and recredentialing for physicians, advanced practice providers, behavioral health professionals, and other applicable healthcare providers
• Complete and submit provider enrollment applications with Medicare, New Mexico Medicaid, commercial insurance plans, and other third-party payers
• Maintain and update provider information within CAQH and other payer or credentialing systems
• Track credentialing and enrollment applications from initial submission through approval
• Follow up with insurance carriers and other organizations regarding outstanding applications, documentation, and enrollment status
• Maintain accurate provider credentialing files and databases
• Verify and monitor professional licenses, board certifications, DEA registrations, malpractice coverage, and other required credentials
• Track expiration and renewal dates and proactively obtain updated documentation
• Assist providers with completing applications, obtaining signatures, and submitting required documentation
• Coordinate provider additions, terminations, demographic changes, and other updates with insurance carriers
• Support provider onboarding by ensuring credentialing and payer enrollment requirements are completed accurately and efficiently
• Work closely with Billing, Human Resources, Compliance, clinic leadership, and providers to resolve credentialing or enrollment issues
• Maintain confidentiality of provider and organizational information
• Assist with audits and ensure credentialing documentation remains complete, accurate, and compliant
• Identify delays or discrepancies that could impact provider enrollment or reimbursement and work proactively toward resolution

Requirements

• Previous experience with healthcare credentialing, provider enrollment, medical staff services, or a closely related healthcare administrative function
• Experience with Medicare, Medicaid, and/or commercial payer enrollment strongly preferred
• Knowledge of CAQH and electronic provider enrollment systems preferred
• Familiarity with New Mexico Medicaid enrollment is highly desirable
• Understanding of provider licensing, certifications, DEA registrations, malpractice coverage, and credentialing documentation
• Strong organizational skills and exceptional attention to detail
• Ability to track multiple providers, applications, deadlines, and renewals simultaneously
• Strong written and verbal communication skills
• Comfortable communicating directly with healthcare providers, insurance carriers, and internal departments
• Strong computer skills, including Microsoft Office and healthcare administrative systems
• Ability to independently research issues and follow applications through completion
• Experience within a nonprofit, community health center, FQHC, or similar healthcare environment is a plus

Benefits

• Comprehensive benefits
• Opportunities for professional growth

Pay

$50,000 - $60,000 per year

About us

• Mission-driven nonprofit healthcare organization
• Opportunity to directly support access to healthcare in the Albuquerque community
• Collaborative environment working with providers, clinical leadership, billing, HR, and administrative teams
• Stable organization with an important community mission
• Opportunity to take ownership of provider credentialing and enrollment processes