Credentialing Specialist Lead
About The Position
Manage the full credentialing lifecycle for physicians, NPs, and PAs — including Medicaid, Medicare, and commercial payer enrollments (Empire BCBS, Fidelis, Aetna, etc.). Review and verify provider documents such as medical licenses, DEA, board certifications, malpractice coverage, and CVs. Prepare, track, and submit enrollment applications accurately and within payer timelines. Monitor revalidation and re-credentialing schedules to ensure ongoing compliance. Serve as the primary point of contact for escalated payer or provider inquiries. Partner with internal billing and operations teams to ensure credentialing aligns with billing readiness. Maintain credentialing logs, dashboards, and internal trackers for reporting purposes. Assist in training and supporting new credentialing specialists, ensuring quality and consistency across workflows.
Requirements
- 3+ years of healthcare credentialing experience; dermatology or multispecialty experience preferred.
- Strong knowledge of CAQH, NPPES, Medicaid, Medicare, and commercial payer portals.
- Exceptional attention to detail, organization, and follow-through.
- Excellent communication and interpersonal skills.
- Proficiency in Excel and credentialing systems; experience with eClinicalWorks a plus.
Nice To Haves
- dermatology or multispecialty experience
- experience with eClinicalWorks
Responsibilities
- Manage the full credentialing lifecycle for physicians, NPs, and PAs — including Medicaid, Medicare, and commercial payer enrollments (Empire BCBS, Fidelis, Aetna, etc.).
- Review and verify provider documents such as medical licenses, DEA, board certifications, malpractice coverage, and CVs.
- Prepare, track, and submit enrollment applications accurately and within payer timelines.
- Monitor revalidation and re-credentialing schedules to ensure ongoing compliance.
- Serve as the primary point of contact for escalated payer or provider inquiries.
- Partner with internal billing and operations teams to ensure credentialing aligns with billing readiness.
- Maintain credentialing logs, dashboards, and internal trackers for reporting purposes.
- Assist in training and supporting new credentialing specialists, ensuring quality and consistency across workflows.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
No Education Listed
Number of Employees
11-50 employees
