Credentialing Specialist

Job Summary

Managing the end-to-end provider credentialing and enrollment processes, the part-time Credentialing Specialist will ensure a high-touch provider experience while addressing complex issues and maintaining compliance in a virtual environment.

Key responsibilities

• Own the provider credentialing and enrollment processes from onboarding through approval and ongoing maintenance
• Serve as the primary escalation point for complex credentialing issues, collaborating with third-party vendors and insurance payors
• Oversee the collection, validation, and maintenance of provider data and onboarding documentation for accuracy and compliance

Required qualifications

• Minimum of 2 years of direct provider enrollment and credentialing experience
• Working knowledge of Medicare, Medicaid, and commercial payor enrollment processes
• Familiarity with CAQH, NPPES, PECOS, and various payor portals
• High School diploma or GED required; Associate's or Bachelor's degree preferred
• 2-3 years of administrative experience in a healthcare environment preferred