Credentialing Specialist - On Site Position

Park DuValle Community Health•Louisville, KY

3d•Onsite

About The Position

Responsible for managing the complete enrollment and revalidation lifecycle for healthcare providers with federal and state programs, commercial payers, Managed Care Organizations (MCOs), and delegated credentialing entities. This role ensures timely and accurate submission of applications, prevents gaps in reimbursement, and maintains up-to-date provider data across all payer systems. Works closely with a credentialing vendor, human resources, revenue cycle, compliance, and clinical leadership to support smooth onboarding and payer participation for all licensed clinical professionals.

Requirements

Associate’s degree in healthcare administration, business or related field + two years of experience in provider enrollment, payer credentialing, and revenue cycle management OR four years of relevant experience.
Strong understanding of Medicare PECOS, Medicaid portals, CAQH, and commercial payer enrollment requirements.
Knowledge of healthcare credentialing & privileging processes, standards, and regulatory requirements.
Excellent communication, organizational, and problem-solving skills.
High level of attention to detail and ability to manage multiple deadlines.
Proficient in MS Office and good knowledge of relevant software and databases.

Responsibilities

Act as Park Duvalle Community Health Center’s liaison between our Credentialing Vendor and providers.
Coordinates with the credentialing vendor to collect information required for enrollment and revalidation of providers and locations.
Provides oversight and reviews the credentialing vendor activities to ensure accurate and timely submissions and updates to payors and the EMR system.
Prepares, submits, and tracks enrollment, re-enrollment, and revalidation applications with Medicare, Medicaid, and commercial health plans.
Maintains thorough documentation of application requirements, status updates, and payer confirmations.
Monitors and resolves enrollment issues including rejections, terminations, or discrepancies.
Communicates changes such as address updates, practice locations, reassignment of benefits, and panel participation to credentialing vendor.
Partners with HR and credentialing vendor to ensure primary-source verification documents align with payer requirements.
Follow up on credentialing denials and appeals requests from payors in a timely manner.
Performs other duties as assigned.