Credentialing Specialist

We are seeking a detail-oriented Credentialing Specialist to manage and streamline the credentialing process for our healthcare providers. This role involves maintaining accurate records, coordinating with various insurance payers, and ensuring timely submission and renewal of all necessary credentials. The ideal candidate will have experience working with multiple credentialing portals and a strong understanding of payer requirements to support provider network participation and compliance.

Key Responsibilities

- Manage credentialing portals including CAQH, NPPES, PECOS, and other relevant systems.
- Submit and track credentialing applications and DEA registration forms, ensuring all documentation is complete and accurate.
- Handle ERA (Electronic Remittance Advice) and EFT (Electronic Funds Transfer) enrollment processes with insurance payers.
- Coordinate communication with Medicare, Medicaid, and commercial insurance companies to facilitate provider participation.
- Maintain organized and up-to-date credentialing records for all providers.
- Follow up regularly with payers to verify network participation status and resolve any issues related to provider enrollment.
- Ensure all provider credentials are renewed on time to maintain compliance and uninterrupted network access.

Required Qualifications

- Proven experience managing healthcare credentialing processes and working with credentialing portals such as CAQH, NPPES, and PECOS.
- Familiarity with DEA registration and insurance payer enrollment procedures.
- Strong organizational skills with the ability to maintain detailed and accurate records.
- Excellent communication skills to effectively coordinate with insurance payers and internal teams.
- Ability to manage multiple tasks and deadlines in a fast-paced environment.

Preferred Qualifications and Benefits

- Experience with ERA/EFT enrollment and knowledge of payer reimbursement processes is highly desirable.
- Prior work with Medicare, Medicaid, and commercial insurance credentialing preferred.
- Opportunity to work in a collaborative environment focused on professional growth and healthcare compliance.

This position offers the chance to play a critical role in supporting provider network participation and ensuring smooth credentialing operations within a dynamic healthcare organization.