Credentialing Specialist

TEKsystems

10d•$23 - $23•Remote

About The Position

Prepare and submit enrollment and re-enrollment applications for healthcare providers to Medicare, Medicaid, and commercial insurance plans. Maintain accurate and up-to-date provider records in internal databases and payer portals. Track application statuses and follow up with payers to ensure timely processing. Collaborate with providers and credentialing staff teams to gather required documentation and resolve discrepancies. Monitor and manage re-credentialing and revalidation timelines to ensure continuous participation. Respond to inquiries from providers and internal departments regarding enrollment status and requirements. Assist with audits and reporting related to provider enrollment activities.

Requirements

High school diploma or equivalent required; associate or bachelor’s degree in healthcare administration or related field preferred.
2-4 years of experience in provider enrollment or credentialing.
Strong understanding of Medicare, Medicaid, and commercial insurance enrollment processes.
Excellent organizational, communication, and problem-solving skills.
Ability to manage multiple tasks and meet deadlines in a fast-paced environment.
Familiarity with CAQH

Responsibilities

Prepare and submit enrollment and re-enrollment applications for healthcare providers to Medicare, Medicaid, and commercial insurance plans.
Maintain accurate and up-to-date provider records in internal databases and payer portals.
Track application statuses and follow up with payers to ensure timely processing.
Collaborate with providers and credentialing staff teams to gather required documentation and resolve discrepancies.
Monitor and manage re-credentialing and revalidation timelines to ensure continuous participation.
Respond to inquiries from providers and internal departments regarding enrollment status and requirements.
Assist with audits and reporting related to provider enrollment activities.