Insurance Credentialing Specialist

TOTAL CARE THERAPY LLC • Dublin, OH

1d

About The Position

The Insurance Credentialing Specialist is responsible for managing and maintaining the credentialing and re-credentialing process for healthcare providers with insurance payers, government programs, and regulatory bodies. This role ensures that all providers meet compliance requirements and are enrolled accurately and efficiently to support timely reimbursement and uninterrupted patient care.

Requirements

• High school diploma
• Knowledge of CAQH, NPPES, PECOS, and provider enrollment processes
• Strong attention to detail and organizational skills
• Excellent communication and problem-solving abilities
• Proficient in credentialing software, practice management systems, and Microsoft Office
• Accuracy and compliance focus
• Ability to manage multiple deadlines
• Professional and proactive communication
• Strong analytical and documentation skills
• Confidentiality and data integrity

Nice To Haves

• Associate or bachelor’s degree preferred
• Prior experience in credentialing, medical billing, or healthcare administration strongly preferred

Responsibilities

• Complete and submit initial credentialing, re-credentialing, and enrollment applications to insurance companies, Medicare/Medicaid, and other payer systems.
• Maintain up-to-date provider files, including licenses, certifications, malpractice insurance, CAQH profiles, and other required documentation.
• Monitor expirables and ensure timely updates to prevent lapses in participation or reimbursement.
• Track application status, follow up with payers, and resolve delays or discrepancies.
• Serve as a liaison between providers, practice administrators, billing staff, and insurance representatives.
• Verify provider credentials and ensure compliance with payer and regulatory requirements.
• Manage database entries and maintain accurate electronic records.
• Assist with audits, compliance reviews, and reporting as needed.
• Communicate changes in payer policies or credentialing requirements to leadership and staff.
• Support the onboarding process by ensuring new providers are enrolled with all necessary payers in alignment with start dates.

Benefits

• Comprehensive benefits package including medical, dental, and vision insurance
• 401(k) retirement plan with company matching
• Paid time off to help you recharge and maintain balance
• Supportive, Growth-Focused Culture
• Opportunities for training, mentorship, and career advancement

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED