Credentialing and Enrollment Specialist

Centerpoint Health•Franklin, OH

11d

About The Position

The Credentialing and Enrollment Specialist supports the Revenue Cycle Management (RCM) department by managing provider credentialing, payer enrollment, and compliance activities across the organization. Reporting directly to the Director of RCM, this role ensures all providers are accurately credentialed, enrolled, and paneled with federal, state, and commercial payers. The specialist acts as a central liaison between Human Resources, executive leadership, and external payers to promote organizational readiness, regulatory compliance, operational efficiency, and timely reimbursement.

Requirements

High School diploma or equivalent. Demonstrated experience in credentialing, payer enrollment, or revenue cycle operations.
2–3 years of experience in credentialing, payer enrollment, revenue cycle operations, or related fields.
Knowledge of JCAHO, HRSA, CMS, and commercial payer credentialing standards.
Working knowledge of medical insurance, claim workflows, and reimbursement processes.
Understanding of ICD‑10, CPT, and HCPCS coding conventions.
Strong attention to detail and organizational abilities.
Effective communication and customer service skills.
Ability to analyze account issues and follow through to resolution.
This position is contingent upon a successful credentialling, background check and drug screen.

Nice To Haves

associate or bachelor's degree in healthcare administration, business, or related field.
Experience working within a Federally Qualified Health Center (FQHC) or multi-specialty provider environment.
Familiarity with NPI registration, PECOS, CAQH, Medicaid/Medicare enrollment portals, and payer contracting systems.

Responsibilities

Payer Enrollment, Credentialing & Paneling
Collaborates closely with Human Resources to obtain all documentation required for credentialing, payer enrollment, and onboarding of new providers.
Provides clear, real-time communication and transparency regarding the credentialing and enrollment status of all billable providers. Provides timely communication and transparency regarding the credentialing and enrollment status of all billable providers. Time communication and transparency regarding the credentialing and enrollment status of all billable providers.
Panels all providers with applicable payers, including but not limited to: Medicaid, Medicare, Managed Medicaid, Managed Medicare, Marketplace Exchange plans, and all major commercial insurers.
Completes and maintains all practitioner credentialing files in compliance with NCQA, and HRSA standards, ensuring accuracy and confidentiality.
Coordinates all credentialing and privileging processes, including the initiation of re-credentialing activities and monitoring licensure compliance for practitioners and nurses.
Assists Human Resources in credentialing- and privileging-related workflows such as reference checks, new hire documentation, and maintenance of personnel folders, hiring documentation. -hire documentation, and maintenance of personnel folders.
Be the primary designee for data entry into HRSA’s Electronic Handbooks for credentialing information. This includes data for CPH, all providers, and any other licensed personnel submissions required to remain compliant with the Federal Tort Claims Act (FTCA). Contracting & Negotiations
Reviews all payer contracts and amendments; negotiates rates, terms, and language as appropriate to support organizational strategy.
Works collaboratively with the CEO/CFO, Director of RCM, and legal counsel for contract review and approval. Organizational Enrollment & Compliance
Enrolls and maintains the organization’s NPIs, Medicaid provider numbers, Medicare PTANs, and other required identifiers to support expansion of services, sites, and programs.
Ensures all credentialing and enrollment records are current, compliant, and audit ready.
Works with the Executive Administrative Assistant in obtaining all Board information as it relates to CPH’s members to maintain registration with Medicare/Medicaid. Committee Coordination & Administrative Support
Facilitates the Clinician Review Committee, including preparation of materials, meeting coordination, and logistical support.
Submits credentialed applicants’ CVs to the Administrative Assistant for inclusion in Board of Trustees' documentation.
Manages day-to-day administrative tasks such as drafting correspondence, preparing presentations, and issuing provider letters. Additional Responsibilities
Maintains strict confidentiality with all records, documentation, and communications.
Assists the Director of RCM with billing-related operations as requested.
Performs additional duties as assigned by the Director of RCM or executive leadership.