Credentialing Specialist

POSITION SUMMARY

The Credentialing Specialist is responsible for managing the credentialing, recredentialing, licensing and payer enrollment processes for healthcare providers to ensure uninterrupted patient care and compliance with all regulatory requirements. This role requires meticulous attention to detail and the ability to work collaboratively with internal teams, providers, and payer representatives. As our business continues to grow, the scope of responsibilities may evolve to meet organizational needs.

PRIMARY RESPONSIBILITIES

• Accurately maintain and update provider credentialing and payer enrollment records in CAQH, PECOS, credentialing software, and other payer-specific systems across multiple states.
• Manage and monitor all aspects of the payer enrollment and re-enrollment process to ensure timely and successful participation with contracted insurance plans.
• Analyze provider credentialing and enrollment files for co...