Credentialing Specialist

Desert Spine & Sports Physicians • Phoenix, AZ

6h

About The Position

Desert Spine & Sports Physicians is a growing, multi-specialty medical practice seeking a Credentialing Specialist to manage provider credentialing and enrollment, work through issues with insurance payers, and help ensure providers are ready to see patients. The role requires ownership, effective communication, attention to detail, and a focus on improving processes as the organization grows.

The specialist will manage provider credentialing, enrollment, and recredentialing from application through approval; track provider status, outstanding requirements, and deadlines; and help internal teams understand credentialing timelines, provider readiness, and the information needed to keep applications moving. The role also involves learning the organization’s providers, specialties, payer relationships, workflows, and credentialing requirements, then establishing consistent tracking, proactive renewal monitoring, and repeatable workflows.

During the first month, the specialist will learn current processes with key stakeholders, review provider files and enrollment materials, identify missing documentation and risks, and establish an inventory of provider status. By the second month, the specialist will review records for gaps, establish baseline measures, develop a prioritized 30-60-90-day action plan, and implement a tracking method. By the third month, the specialist will begin addressing high-priority issues, establish proactive expiration and recredentialing monitoring, provide regular status updates, and create a repeatable follow-up and escalation process.

The role works within a growing, multi-specialty medical practice and collaborates with Human Resources, practice leadership, providers, billing, and other operational teams. It requires independent ownership, consistent follow-through, proactive communication, and the ability to identify and resolve issues before they become larger problems. Challenges may include varying payer requirements and timelines, incomplete documentation, competing priorities, inconsistent historical records, payer delays, and increasing credentialing volume and complexity.

Requirements

• At least 3 years of healthcare credentialing and enrollment experience.
• Computer skills including PDF, Microsoft Word, Excel, and basic data entry.
• Ability to learn new and complex computer system applications.
• Strong oral and written communication skills and ability to interact with all levels of internal and external contacts.
• Ability to prioritize, plan, and handle multiple tasks and demands simultaneously.

Responsibilities

• Manage provider credentialing, enrollment, and recredentialing from application through approval.
• Track provider status, outstanding requirements, deadlines, payer participation, effective dates, and upcoming renewals.
• Review provider files, payer applications, CAQH profiles, and enrollment records to identify gaps, missing documentation, risks, and deadlines.
• Communicate credentialing timelines, provider readiness, and application requirements to internal teams, and establish clear handoffs.
• Develop and maintain consistent tracking, renewal monitoring, and repeatable workflows.
• Establish baseline measures and develop a prioritized action plan for credentialing issues, deadlines, follow-ups, and escalations.
• Address high-priority credentialing gaps and outstanding applications.
• Provide regular updates on credentialing status, at-risk items, pending payer decisions, and resolution plans.
• Follow up with payers and other parties, escalating delays before they cause operational or reimbursement issues.
• Collaborate with Human Resources, practice leadership, providers, billing, and other operational teams.

Benefits

• Medical insurance
• Dental insurance
• Vision insurance
• Life insurance
• 401(k) match
• Paid time off
• Exposure to multiple medical specialties and insurance payer networks
• Opportunities to develop expertise in credentialing and provider enrollment
• Collaborative team environment with opportunities for continued learning and career growth

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed