Credentialing Specialist

Responsibilities

• Manage the collection, review, and tracking of credentialing materials for both newly onboarding and existing providers.
• Communicate with providers, insurance plans, and internal stakeholders to obtain missing information and resolve documentation issues promptly.
• Oversee submission workflows for credentialing and privileging applications, ensuring records are processed accurately and on schedule.
• Maintain organized provider files and support the distribution and storage of credentialing documents in accordance with established procedures.
• Monitor enrollment and re-credentialing timelines for Medicare, Medicaid, and other payer networks to help avoid lapses in participation.
• Build and update credentialing databases, reports, and alert systems to improve visibility into application status and expiration dates.
• Ensure credentialing activities align with applicable regulations, payer standards, and organizational policies.
• Handle day-to-day administrative tasks related to provider credentialing and troubleshoot issues that may delay approval or enrollment.

Requirements

• Prior experience in provider credentialing, physician credentialing, or a closely related healthcare administration function.
• Working knowledge of credentialing processes, including initial enrollment, privileging support, and re-credentialing applications.
• Familiarity with payer enrollment requirements for Medicaid, Medicare, and commercial insurance plans.
• Strong attention to detail with the ability to manage high-volume documentation accurately.
• Effective organizational and follow-up skills, with the ability to track multiple deadlines and status updates at once.
• Comfortable working independently while also collaborating with providers and cross-functional teams.
• Proficiency with credentialing databases, spreadsheets, and standard administrative systems.

Qualifications

The ideal candidate will have a bachelor's degree in a relevant field and a minimum of 3 years of experience in provider credentialing, physician credentialing, or a closely related healthcare administration function.