Payer Credentialing Specialist

WOUND CENTRICS LLC-posted about 4 hours ago
Full-time • Mid Level
Hybrid • New Braunfels, TX
101-250 employees
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We are a dynamic and growing medical group dedicated to delivering high-quality patient care through excellence in operations and compliance. We are seeking a skilled Payer Credentialing Specialist to join our team. This role focuses exclusively on payer enrollment and contract maintenance for our physicians and advanced practice providers. Position Overview: The Payer Credentialing Specialist will oversee all aspects of provider enrollment, payer applications, and maintenance across commercial and government insurance plans. The ideal candidate has a deep understanding of payer credentialing workflows, insurance plan requirements, and timeline management, ensuring seamless participation and timely reimbursement for our providers.

  • Manage end-to-end payer enrollment and recredentialing for all providers within the medical group.
  • Prepare, submit, and track applications with commercial and government payers (Medicare, Medicaid, BCBS, Aetna, Cigna, UnitedHealthcare, etc.).
  • Maintain accurate provider records in CAQH, NPPES, PECOS, Availity, and other payer portals.
  • Coordinate with internal teams to ensure alignment between credentialing, contracting, and billing operations.
  • Track and manage effective dates, payer IDs, and credentialing expirables to prevent lapses in participation.
  • Resolve payer-related credentialing issues and follow up to ensure timely approvals.
  • Maintain compliance with payer-specific requirements and state/federal regulations.
  • Assist in payer audits and compliance reviews related to credentialing.
  • Minimum 5 years of payer credentialing experience in a medical group, MSO, or healthcare organization.
  • Deep understanding of payer enrollment processes and credentialing best practices.
  • Experience with CAQH, PECOS, and payer portals (e.g., Availity).
  • Familiarity with HIPAA and CMS regulations.
  • Strong attention to detail, organization, and follow-up.
  • Excellent written and verbal communication skills.
  • CPCS or CPMSM certification preferred.
  • Competitive salary and benefits package
  • Flexible work environment (remote/hybrid options available)
  • Collaborative and supportive team culture
  • Opportunity to work in a compliance-driven, growth-oriented organization
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