Credentialing & Payer Enrollments Specialist

Together Women's Health•Grosse Pointe, MI

About The Position

Together Women’s Health (TWH) is adding a Credentialing & Payer Enrollments Specialist to be an important member of our accounting team. We are seeking a detail-oriented and experienced Credentialing and Payer Enrollments Specialist to join our healthcare organization. This position is responsible for managing the complete credentialing lifecycle for healthcare providers and ensuring timely enrollment with insurance payers. The ideal candidate will have extensive knowledge of credentialing requirements, payer enrollment processes, and regulatory compliance in the healthcare industry.

Requirements

Minimum 3 years of experience in healthcare credentialing and payer enrollment
2-year college degree with additional training, experience and related certifications is required
Proficiency in credentialing software platforms (CAQH ProView, PECOS, state Medicaid portals)
Strong computer skills including Microsoft Office Suite, database management, and electronic filing systems
Experience with primary source verification processes and requirements
Familiarity with NPDB, OIG exclusion lists, and other verification databases
Exceptional attention to detail and accuracy
Strong organizational and time management abilities
Excellent written and verbal communication skills
Ability to work independently and manage multiple priorities simultaneously
Problem-solving skills and ability to navigate complex regulatory requirements
Commitment to maintaining confidentiality and handling sensitive information

Nice To Haves

Previous experience with credentialing software systems and databases
Knowledge of medical terminology and healthcare organizational structures
Experience with Athena Healthcare EMR or Modio Health software is a plus

Responsibilities

Initiate and manage the credentialing process for new providers, including physicians, nurse practitioners, physician assistants, and other healthcare professionals
Collect, verify, and maintain all required credentialing documentation including licenses, certifications, education verification, work history, malpractice insurance, and references
Ensure compliance with state and federal regulations, accreditation standards, and organizational policies
Coordinate primary source verification for all credentialing elements
Maintain detailed tracking systems and databases for all credentialing activities
Prepare and submit credentialing applications to hospitals, health systems, and other healthcare facilities
Complete enrollment applications for providers with commercial insurance plans, Medicare, Medicaid, and other third-party payers
Monitor enrollment status and follow up on pending applications
Maintain current knowledge of payer-specific enrollment requirements and deadlines
Coordinate with providers to obtain necessary documentation and signatures
Ensure accurate provider demographic and practice information across all payer systems
Manage provider directory updates and changes
Monitor expiration dates for licenses, certifications, malpractice insurance, and other time-sensitive documents
Initiate re-credentialing processes in advance of expiration dates
Update provider information with payers as needed for address changes, specialty additions, or other modifications
Maintain organized filing systems for all credentialing and enrollment documentation
Ensure all credentialing activities comply with NCQA, URAC, Joint Commission, and other relevant standards
Conduct regular audits of credentialing files to ensure completeness and accuracy
Stay current with changing regulations and industry best practices
Participate in accreditation surveys and provide necessary documentation
Serve as primary liaison between providers, payers, and internal stakeholders
Provide regular status updates to leadership and providers regarding credentialing progress
Resolve credentialing issues and barriers in a timely manner
Collaborate with Revenue Cycle Management team to ensure billing capability following enrollment completion