Credentialing Services Specialist

Dean Dorton•Raleigh, NC

About The Position

The Credentialing Services Specialist ensures healthcare providers are accurately credentialed and enrolled with payers to support efficient reimbursements and uninterrupted patient care. The role manages credentialing applications, licensure tracking, and ongoing compliance across multiple states and payer types. It requires accuracy, confidentiality, organization, and the ability to work effectively in a fast-paced environment while providing precise, compliant, and timely services to clients. The specialist manages provider credentialing and enrollment, maintains provider records, completes applications and updates in credentialing systems and payer portals, monitors renewals and revalidations, and resolves credentialing issues. The role also communicates payer requirements and policy changes, supports compliance, collaborates with clients and colleagues, and contributes to internal training, knowledge-sharing, and process improvement.

Requirements

Minimum of 2 years of experience in provider credentialing, preferably across multiple payers and specialties.
Familiarity with EFT setup, payer enrollment, and credentialing requirements across multiple states.
Strong attention to detail, organization, and record-keeping skills.
Ability to manage multiple priorities accurately under tight deadlines.
Commitment to confidentiality and compliance with HIPAA regulations.
Strong communication and customer service skills.

Nice To Haves

Experience with Intellisoft and CAQH databases.

Responsibilities

Manage provider credentialing and enrollment processes with Medicare, Medicaid, and commercial payers.
Initiate payer contracts for new physician practices and monitor revalidations and renewals.
Maintain accurate provider records, including licensure, certifications, malpractice insurance, and DEA registration.
Complete applications and updates in Intellisoft, CAQH, and payer-specific portals.
Track and resolve credentialing-related issues to ensure uninterrupted claim processing and payment.
Research credentialing requirements and payer policy changes, and share updates with clients and team members.
Ensure compliance with federal, state, and payer-specific credentialing regulations.
Communicate proactively and professionally with clients, providers, and payer representatives.
Manage multiple credentialing projects while meeting deadlines and maintaining quality.
Maintain discretion, professionalism, and adherence to HIPAA and confidentiality standards.
Collaborate with internal team members to improve workflows and client satisfaction.
Identify process efficiencies and contribute to team success and continuous improvement initiatives.
Participate in internal training and development programs to maintain current knowledge of credentialing regulations and payer trends.
Document best practices and credentialing updates to support internal knowledge-sharing.
Assist in mentoring or cross-training new team members.
Represent the firm's values of integrity, collaboration, and client service in professional interactions.