Credentialing Specialist (Fully Remote)

Aspirion•Las Vegas, NV

5d•Remote

About The Position

The Credentialing Specialist is responsible for coordinating and maintaining all aspects of provider credentialing, recredentialing, enrollment, and data management activities. This role ensures healthcare providers meet all regulatory, payer, and organizational requirements to maintain active participation with commercial and government insurance plans. The Credentialing Specialist serves as a liaison between providers, payers, internal departments, and external organizations to ensure timely and accurate credentialing and enrollment processes.

Requirements

Strong understanding of credentialing, provider enrollment, and recredentialing processes.
Knowledge of Medicare, Medicaid, and commercial payer requirements.
Familiarity with CAQH, NPPES, PECOS, and payer enrollment portals.
Excellent organizational skills with the ability to manage multiple deadlines simultaneously.
Strong attention to detail and commitment to accuracy.
Effective verbal and written communication skills.
Ability to work independently and prioritize workload in a fast-paced environment.
Proficiency with Microsoft Office Suite, including Excel, Word, and Outlook.
Strong problem-solving and follow-up skills.

Nice To Haves

High school diploma or equivalent.
Minimum of 2 years of credentialing, provider enrollment, healthcare administration, or related experience.
Associate or bachelor's degree in healthcare administration, Business Administration, or a related field preferred.
Certified Provider Credentialing Specialist (CPCS) designation or willingness to obtain certification.
Experience credentialing providers across multiple states and payer networks.
Experience within healthcare revenue cycle management, physician practice management, or healthcare consulting organizations.
Experience working with credentialing databases and provider management systems preferred.

Responsibilities

Manage the initial credentialing, recredentialing, and provider enrollment processes as assigned.
Prepare, submit, and monitor credentialing applications to hospitals, health plans, government payers, and other credentialing entities.
Maintain provider information within credentialing databases and ensure accurate and current records.
Track provider credential expiration dates, including licenses, certifications, DEA registrations, malpractice insurance, and other required documentation.
Proactively obtain renewal documentation to prevent credentialing lapses.
Monitor application status and follow up with payers and credentialing organizations for timely processing.
Maintain compliance with federal, state, payer, and organizational credentialing requirements.
Conduct primary source verification as required by accreditation and regulatory standards.
Review provider files for completeness and accuracy before submission.
Assist with provider enrollment, revalidation, and demographic updates with Medicare, Medicaid, and commercial insurance carriers.
Respond to credentialing inquiries from providers, leadership, clients, and payer representatives.
Prepare credentialing reports and provide status updates to leadership as requested.
Support audits and accreditation reviews by maintaining organized and compliant provider files.
Collaborate with internal departments to resolve credentialing and enrollment issues impacting provider participation or reimbursement.
Maintain confidentiality of sensitive provider and organizational information.