Credentialing Specialist

Job Summary

Managing the full scope of provider credentialing and payer enrollment functions, the full-time Credentialing Specialist will ensure timely and compliant provider onboarding while collaborating with various departments in a remote work environment.

Key Responsibilities

• Coordinate the end-to-end process of initial credentialing, recredentialing, and payer enrollment for healthcare providers
• Ensure accurate documentation and compliance with internal policies and regulatory standards
• Serve as the liaison between credentialing and other departments, tracking progress and resolving issues

Required Qualifications

• Minimum of two years of experience in provider credentialing or payer enrollment
• High School Diploma or General Education Development (GED) required
• Proficiency with CAQH, PECOS, NPPES, and payer enrollment portals
• Familiarity with CMS regulations and Hawaii-specific Medicaid requirements
• Strong time management skills and attention to detail