Credentialing Specialist (Payer Enrollment)

Essential Duties and Responsibilities

• Prepare, submit, and track provider enrollment applications, re-credentialing packets, and demographic updates with commercial and government payers in a timely manner.
• Proactively communicate with insurance representatives to monitor application status, resolve processing issues, and reduce approval turnaround times.
• Accurately maintain and audit provider data within credentialing systems and databases such as CAQH, PECOS, and NPPES.
• Work closely with billing, credentialing, and HR teams to ensure alignment and accuracy of provider information across all internal systems and platforms.
• Investigate and resolve claim denials, rejections, or payment delays resulting from enrollment discrepancies, provider data issues, or taxonomy errors.

Qualifications/Requirements

• Minimum of 2 years of payer enrollment and provider credentialing experience in a healthcare setting.
• CQAQ experience required.
• Strong understanding of provider credentialing and payer enrollment processes.
• Familiarity with provider identifiers, including NPI (National Provider Identifier) and TIN (Tax Identification Number).
• Excellent organizational skills with the ability to manage multiple priorities in a fast-paced environment.
• Strong verbal and written communication skills.
• High level of accuracy and attention to detail.
• Ability to build and maintain effective working relationships with providers, internal teams, and external payer contacts.
• Proficiency in Microsoft Office applications (Word, Excel, and Access) and credentialing software platforms.
• Experience with MD Staff or similar credentialing software is preferred.