Credentialing Specialist

Metro Vein Centers•West Bloomfield, MI

3d•Remote

About The Position

As a Credentialing Specialist at Metro Vein Centers, you are an integral team member to our continued growth. This role is responsible for provider credentialing, payer enrollment, and recredentialing to ensure clean participation, timely effective dates, and uninterrupted patient access and reimbursement. Reporting to the Supervisor of Credentialing, you’ll work daily in CAQH, payer portals (e.g., Availity), Medicare PECOS, and our credentialing database, collaborating closely with Recruitment, Clinical leadership, and RCM. The ideal candidate is detail-oriented, process-driven, and has experience in provider enrollment. This is a remote role; we’re looking for a self-starter with strong ownership and follow-through.

Requirements

2+ years in provider credentialing and/or payer enrollment (physician group, MSO, health plan, or hospital).
Hands-on with CAQH (attestations/rosters), Medicare PECOS, and payer portals (e.g., Availity).
Working knowledge of Medicare/Medicaid and commercial enrollment rules.
Proficient in credentialing systems (e.g., MD-Staff/Cactus) and Excel/Google Sheets.
Strong data accuracy and documentation habits; able to maintain clean provider records across multiple systems.
Effective written/verbal communication with payers, providers, and internal stakeholders; escalates issues appropriately.
Proven ability to prioritize in a high-volume environment, meet deadlines, and follow SOPs with minimal supervision.
Self-starter mindset with ownership and follow-through in a remote setting.
High school diploma or equivalent required

Responsibilities

Submit and track provider enrollments across Medicare/Medicaid (PECOS) and commercial payers (e.g., Availity) to secure effective dates.
Identify network expansion opportunities by enrolling providers into additional payer products, plans, and service locations.
Maintain CAQH attestations and accurate provider data across payer portals and internal credentialing systems.
Monitor re-validations/re-credentialing and manage expirables to prevent participation lapses.
Assist with onboarding new providers: gather documents, set up NPI/taxonomy/locations, and coordinate start-date readiness.
Respond to payer requests, supply additional documentation, and resolve application issues promptly.
Escalate concerns and complex cases to the Supervisor of Credentialing for timely resolution and participate in special projects as needed.