Credentialing Specialist

Codecure AI seeks a dedicated Credentialing Specialist with 2 to 3 years of experience in medical and behavioral health credentialing to join our team. In this role, you ensure that healthcare providers are properly credentialed to deliver high-quality service within compliance guidelines. You will interact with various healthcare portals such as CAQH, PECOS, and NPPES to manage provider credentials and maintain up-to-date licensing, DEA registration, and board certifications. This position does not include team management responsibilities but requires strong organizational skills and independent follow-through to support our credentialing processes efficiently. The Credentialing Specialist will play a critical role in navigating Medicare, Medicaid, and commercial payer enrollment practices, assuring all compliance regulations are met. Effective communication, meticulous attention to detail, and the ability to utilize credentialing software tools are essential for success. By maintaining accurate and current credentialing data, you help Codecure AI provide trusted healthcare solutions while adhering to industry standards and regulatory requirements.
Responsibilities

Manage the complete credentialing lifecycle for healthcare providers including applications, verification, and renewals across multiple platforms.
Verify provider credentials such as licensing, DEA registration, board certifications, and education history using CAQH, PECOS, NPPES, and similar credentialing portals.
Maintain accurate and organized records to ensure compliance with healthcare regulations and payer requirements.
Monitor and track expiration dates for licenses, certifications, and insurance to initiate timely re-credentialing processes.
Coordinate communication with healthcare providers, insurance companies, and regulatory bodies to resolve credentialing discrepancies or issues.
Ensure full compliance with Medicare, Medicaid, and commercial insurance enrollment processes and stay current with regulatory changes.
Utilize credentialing software tools like CAQH and Availity efficiently to update and verify provider information.
Prepare and submit credentialing applications and documentation according to payer and regulatory standards.
Conduct routine audits of provider files and credentialing data to maintain data integrity and regulatory compliance.
Follow up proactively on pending credentialing applications and resolve any outstanding issues in a timely manner.
Collaborate with internal departments to facilitate provider onboarding and credentialing-related inquiries.
Stay informed about updates in healthcare compliance regulations impacting credentialing procedures and requirements.