Payor Credentialing Specialist

The Payor Credentialing Specialist at ERC Pathlight performs duties associated with payor enrollment, credentialing, re-credentialing, and privileging network providers. Essential Duties And Responsibilities:

• Coincide the credentialing, recredentialing, and provider enrollment process for physicians, advanced practice providers, and allied health professionals.
• Complete, review, and submit credentialing and enrollment applications to Medicare, Medicaid, commercial insurance carriers, and managed care organizations.
• Maintain provider records in credentialing databases: MD Staff, CAQH, PECOS, NPPES, and other applicable systems, enabling tracking of credential expiration dates and maintenance of audit-ready files.
• Coordinate with providers and internal departments to obtain required documentation and respond to requests from payors for additional information.
• Research and resolve credentialing and enrollment issues affecting provider participation and reimbursement.
• Generate credentialing reports, maintain enrollment status reports, and support internal and external audits.
• Ensure compliance with federal and state regulations, accreditation standards, HIPAA, and organizational policies; communicate credentialing status updates to leadership and providers.
• Participate in process improvement initiatives.

Willingness to work occasional nights and weekends with up to 25% of travel required.

Requirements

• A high school diploma or equivalent.
• A bachelor's degree in business, healthcare, or a related field of study.
• At least 3 years of experience in healthcare facility credentialing and physician credentialing.
• A certification as a Certified Provider Credentialing Specialist (CPCS) or Certified Provider Enrollment Specialist (CPES) by the National Association of Medical Staff Services (NAMSS).

Skills and Abilities

• Strong organization skills.
• Detail-oriented.
• Ability to multi-task and prioritize.
• Able to communicate in a professional manner both verbally and in writing.

What We Offer

• Competitive compensation.
• Comprehensive medical, dental, and vision coverage.
• Broad Paid Time Off.
• Parental leave benefits.
• Roth IRA retirement benefits.
• Tuition reimbursement.