Credentialing Specialist

Job Summary

Guiding healthcare providers through complex insurance enrollment and credentialing activities, the remote Credentialing & Enrollment Specialist will manage provider credentialing and payer enrollment processes while coordinating with external organizations to resolve issues.

Key Responsibilities

• Oversee provider credentialing and payer enrollment activities from initiation through completion, including Medicare and commercial insurance requests
• Coordinate complex enrollment cases involving new payer arrangements and maintain accurate information throughout the enrollment process
• Guide physicians through detailed enrollment requirements and manage an active workload of approximately 100 cases

Required Qualifications

• At least 2 years of relevant experience in healthcare credentialing, provider enrollment, or payer relations
• Previous experience working directly with insurance carriers and familiarity with Medicare and commercial payer enrollment processes
• Hands-on experience using provider credentialing or enrollment platforms such as CAQH, PECOS, or NPPES
• Strong communication and relationship management skills to navigate complex conversations with physicians
• Demonstrated problem-solving and organizational skills with the ability to manage a large active caseload