Medical Credentialing Specialist

We are looking for a highly organized and detail-oriented Medical Credentialing Specialist to join our revenue cycle management team. The successful candidate will oversee the entire credentialing and provider enrollment process for a wide range of healthcare providers. A strong understanding of government payers is essential, with proven hands-on experience specifically in Medicare and Medicaid enrollments.

Key Responsibilities

- Manage the full credentialing, re-credentialing, and enrollment process for healthcare providers with commercial insurance networks as well as government payers.
- Prepare, submit, and monitor initial and re-validation applications for Medicare through PECOS and state Medicaid programs.
- Create, update, and maintain accurate provider profiles in CAQH and the NPPES NPI Registry.
- Track application statuses, proactively follow up with insurance payers to resolve delays, and troubleshoot enrollment denials or discrepancies.
- Maintain current records of provider licenses, DEA certificates, malpractice insurance, and board certifications to avoid coverage gaps.
- Keep provider rosters and internal credentialing databases up to date, ensuring the billing team has accurate effective dates for clean claim submissions.
- Communicate clearly with providers, practice managers, and insurance representatives regarding documentation requirements and application status updates.

Required Qualifications

- Minimum of 2 to 3 years of direct experience in medical credentialing and provider enrollment.
- Extensive, hands-on experience processing Medicare (PECOS) and Medicaid applications is mandatory; candidates without this will not be considered.
- Strong working knowledge of CAQH, NPI, and state medical board licensing requirements.
- Exceptional attention to detail and organizational skills to manage multiple provider files and meet tight deadlines.
- Excellent written and verbal communication skills.
- Ability to work independently and navigate complex payer portals efficiently.

Preferred Qualifications

- Certified Provider Credentialing Specialist (CPCS) certification is highly desirable.
- Experience credentialing providers across multiple states or diverse medical specialties such as Pediatrics, Family Medicine, or Internal Medicine.
- Familiarity with standard EMR/EHR systems and credentialing software.

Benefits

- Competitive salary commensurate with experience.
- Flexible working environment.
- Opportunities for professional growth and skill development.

Interested candidates are encouraged to submit an updated resume detailing their specific experience with Medicare, Medicaid, and overall provider enrollment, along with salary expectations and earliest availability.