Network Provider Enrollment Specialist

Exceed Healthcare•Irving, TX

23h

About The Position

The Payer Credentialing Specialist at Exceed Healthcare is responsible for managing the credentialing and enrollment processes for clients of Exceed Healthcare. This includes maintaining accurate provider data, submitting and tracking enrollment applications, ensuring compliance with payer requirements, and monitoring certifications and licensure. The role involves close collaboration with insurance payers, external vendors, and internal teams to resolve credentialing issues and ensure timely processing. The specialist will also manage provider information in credentialing databases and ensure all data is current and accurate.

Requirements

High school diploma or equivalent required.
Minimum of 1-2 years of experience in payer credentialing, medical staff services, or healthcare administration.
Strong understanding of insurance payer requirements and credentialing processes.
Familiarity with various credentialing databases (e.g., CAQH, PECOS, etc.) and healthcare industry standards.
Proficient in Microsoft Office Suite (Excel, Word, Outlook) and Gsuite.
Excellent attention to detail and accuracy.
Strong organizational and time-management skills with the ability to prioritize multiple tasks.
Knowledge of federal and state regulations regarding provider credentialing (e.g., HIPAA, NCQA, CMS).
Proven time management and prioritization skills focusing on urgent and overlapping deadlines

Nice To Haves

Associate or bachelor’s degree in healthcare, business, or related field preferred.
Previous experience working with insurance payers, networks, and credentialing software is a plus.
Certified Provider Credentialing Specialist (CPCS) or similar credentialing certification (optional, but preferred).
Membership in professional organizations such as the National Association of Medical Staff Services (NAMSS) is a plus.

Responsibilities

Managing the credentialing and enrollment processes for clients of Exceed Healthcare.
Maintaining accurate provider data.
Submitting and tracking enrollment applications.
Ensuring compliance with payer requirements.
Monitoring certifications and licensure.
Collaborating with insurance payers, external vendors, and internal teams to resolve credentialing issues and ensure timely processing.
Managing provider information in credentialing databases and ensuring all data is current and accurate.