Credentialing Specialist

About the role

AmeriPharma is a rapidly growing healthcare company where you will have the opportunity to contribute to our joint success on a daily basis. We value new ideas, creativity, and productivity. We like people who are passionate about their roles and people who like to grow and change as the company evolves.

Responsibilities

• Complete and submit initial and recredentialing applications for providers across all payers and facilities, ensuring accuracy and timely delivery.
• Lead payer enrollment and re-enrollment processes in close coordination with the billing and operations teams.
• Track, maintain, and organize all credentialing documentation, including but not limited to State(s) licenses, DEA, NPI Registry, and board certifications.
• Maintain active credentials across all applicable states and payer networks.
• Ensure all provider data in the credentialing database, including demographics, effective dates, approvals, and denials.
• Monitor expiration dates for credentials and contracts and proactively manage revalidation and renewals.
• Participate in credentialing audits conducted by health plans, ensuring all documentation is accurate, complete, and audit-ready.
• Maintain strong working relationships with payer representatives and facility contacts to ensure timely execution of contracts, amendments, and credentialing audits.
• Ensure full compliance with all regulatory, payer-specific, and credentialing requirements.
• Respond to medical record requests from patients, legal offices, and referring facilities in accordance with HIPAA.
• Cook up the release of information, ensuring proper authorization is on file.
• Maintain accurate tracking logs and follow-up systems for credentialing records and medical record requests.
• Provide regular status reports to the Director of Regulatory Affairs on licensing and payer credentialing, and contracting progress.
• Develop and maintain repeatable workflows for all credentialing processes, including initial enrollment, recredentialing, revalidation, and demographic updates.
• Perform other duties as assigned to support regulatory and credentialing functions.

Requirements

• Strong verbal and written communication skills.
• Excellent interpersonal, sales, and customer service skills.
• Excellent organizational skills and attention to detail.
• Effective time management skills with a proven ability to meet deadlines in a fast-paced environment.
• Strong analytical and problem-solving skills.
• Strong supervisory and leadership skills.
• Ability to prioritize tasks and, when appropriate, delegate effectively.
• Proficient in Microsoft Office Suite or similar software.

Preferred Qualifications

• 1–3 years of experience in credentialing within a PBM, health plan, IPA, or medical group.
• Certified Provider Credentialing Specialist (CPCS) certification preferred.

Education and Experience Requirements

• Bachelor's degree in Healthcare Administration, Business, Finance, or related field; or equivalent combination of education and experience.
• Strong knowledge of Medicare, Medicaid, CAQH, PECOS, NPPES, and commercial payer systems.
• Familiarity with HIPAA regulations and medical record handling.

Physical Requirements

The following physical activities described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions and expectations.

EEO Statement

AmeriPharma values diversity in its workforce and is proud to be an AAP/EEO employer. All qualified applicants will receive consideration for employment without regard to race, sex, color, religion, sexual orientation, gender identity, national origin, age, protected veteran status, or on the basis of disability or any other legally protected class.