PROVIDER CREDENTIALING SPECIALIST

C2Q Health Solutions•New York, NY

16h•$75,000 - $85,000•Onsite

About The Position

The Provider Credentialing Specialist is responsible for managing provider credentialing, payer enrollment, and network participation activities for TeamCare Medical providers and practice locations. This role serves as the primary liaison between providers, insurance carriers, practice managers, and Finance to ensure timely credentialing, successful payer enrollment, and operational readiness. The Specialist supports the growth of the TeamCare Medical brand by expanding insurance network participation, maintaining strong payer and provider relationships, and coordinating the administrative processes necessary for providers and clinics to deliver and bill for services efficiently.

Requirements

Bachelor's degree in Healthcare Administration, Business Administration, Public Health, or equivalent years of experience.
Minimum of 3 years of experience in healthcare credentialing, provider enrollment, payer relations, medical practice administration, or related healthcare operations.
Experience credentialing providers with Medicare, Medicaid, and commercial insurance carriers required.
Experience working with physician practices, clinics, or healthcare organizations preferred.
Experience managing multiple projects, deadlines, and payer relationships simultaneously.
Experience with provider enrollment platforms such as CAQH, PECOS, NPPES, and state Medicaid portals.

Responsibilities

Manage the full lifecycle of provider credentialing, recredentialing, and payer enrollment processes for physicians, nurse practitioners, physician assistants, and other licensed healthcare professionals.
Prepare, submit, and track credentialing applications with commercial insurance carriers, Medicare, Medicaid, and managed care organizations.
Complete and submit enrollment and revalidation for Medicare using PECOS system.
Monitor credentialing and enrollment statuses to ensure timely approvals and minimize delays in provider participation.
Maintain accurate provider records, licenses, certifications, malpractice insurance documentation, and other credentialing requirements.
Coordinate provider updates, demographic changes, and revalidation submissions with insurance carriers and regulatory agencies.
Ensure all credentialing activities comply with regulatory, payer, and organizational requirements.
Maintain and manage a database tracking expiration and renewal dates for all provider credentials, board certification, malpractice insurance coverage, CAQH re-attestations, and Medicaid and Medicare revalidation dates. Proactively notify providers so renewal processes can begin without disruption.
Maintain and manage providers' CAQH, including uploading and refreshing supporting documents (licenses, DEA, malpractice COIs, W9s).
Coordinate and manage the enrollment of new TeamCare Medical practice locations with insurance carriers and payer networks.
Serve as the primary administrative lead for adding clinics, service locations, and providers to payer networks.
Track payer applications, approvals, contracts, and implementation timelines for new locations.
Support initiatives that increase patient access and strengthen TeamCare Medical's presence within payer networks.
Develop and maintain positive working relationships with insurance representatives, provider relations teams, and payer credentialing departments.
Serve as the primary contact for credentialing and enrollment inquiries from providers, practice managers, and insurance carriers.
Proactively resolve credentialing issues, application delays, network participation concerns, and enrollment discrepancies.
Assist providers and practice leadership in understanding payer requirements and credentialing expectations.
Promote a professional and responsive experience that supports provider satisfaction and organizational growth.
Act as the liaison between Finance, Medical Practice Managers, Revenue Cycle, and Medical Operations regarding payer enrollment and provider participation matters.
Coordinate communication related to billing activation, provider effective dates, claims issues, and payer updates.
Ensure provider and clinic information is accurately reflected across credentialing, billing, and operational systems.
Monitor upcoming credentialing expirations and recredentialing deadlines to ensure continuous participation with payers.
Maintain credentialing databases, files, and documentation in accordance with organizational policies and regulatory requirements.
Prepare reports and provide updates to leadership regarding credentialing activities, enrollment timelines, and payer relationships.
Participate in audits and regulatory reviews as required.
Recommend process improvements to enhance efficiency, reduce enrollment timelines, and improve provider onboarding.
Other duties as assigned.