Credentialing Specialist Jobs

About The Position

Requirements

• Minimum of 2 years of experience in provider credentialing, preferably across multiple payers and specialties.
• Familiarity with EFT setup, payer enrollment, and credentialing requirements across multiple states.
• Strong attention to detail, organization, and record-keeping skills.
• Ability to manage multiple priorities accurately under tight deadlines.
• Commitment to confidentiality and compliance with HIPAA regulations.
• Strong communication and customer service skills.

Nice To Haves

• Experience with Intellisoft and CAQH databases.

Responsibilities

• Manage provider credentialing and enrollment processes with Medicare, Medicaid, and commercial payers.
• Initiate payer contracts for new physician practices and monitor revalidations and renewals.
• Maintain accurate provider records, including licensure, certifications, malpractice insurance, and DEA registration.
• Complete applications and updates in Intellisoft, CAQH, and payer-specific portals.
• Track and resolve credentialing-related issues to ensure uninterrupted claim processing and payment.
• Research credentialing requirements and payer policy changes, and share updates with clients and team members.
• Ensure compliance with federal, state, and payer-specific credentialing regulations.
• Communicate proactively and professionally with clients, providers, and payer representatives.
• Manage multiple credentialing projects while meeting deadlines and maintaining quality.
• Maintain discretion and comply with HIPAA and confidentiality standards.
• Collaborate with internal team members to improve workflows and client satisfaction.
• Identify process efficiencies and contribute to team success.
• Participate in internal training and development to maintain current credentialing and payer knowledge.
• Contribute to continuous improvement initiatives within the Healthcare Consulting team.
• Document best practices and credentialing updates to support internal knowledge sharing.
• Assist in mentoring or cross-training new team members.
• Represent the firm’s values of integrity, collaboration, and client service.

Benefits

• Flexible work schedules and environment.
• Paid Time Off (PTO).
• Paid family leave, medical leave, and maternity/paternity leave programs.
• Retirement benefits, including an employer match and automatic profit sharing.
• Telemedicine.
• Mental health resources.
• Wellness program reimbursement.