Credentialing Specialist

About CapitalMed Solutions

CapitalMed Solutions is a healthcare services company providing Revenue Cycle Management, Medical Billing & Coding, Credentialing, Call Center Support, Insurance Verification, Pre-Authorization, HEDIS, Referral Management, Accounting, and Virtual Assistant services. We support medical practices across the United States with compliant, efficient, and accurate back-office operations.

Credentialing Specialist

Position Overview

Credentialing Specialist

You will oversee the entire credentialing lifecycle—initial enrollment, re-credentialing, CAQH management, contracting, directory updates, and payer relationships—to ensure our clients remain compliant and able to bill without interruptions.

Key Responsibilities

1. Provider Enrollment & Credentialing

Prepare, submit, and track provider enrollment and credentialing applications with Medicare, Medicaid, and commercial payers.

Complete initial credentialing for new practices and new providers joining existing groups.

Maintain and update CAQH profiles for providers; ensure attestations are up-to-date.

Verify licenses, board certifications, malpractice insurance, NPI, DEA, CDS, and other required documents.

Review and submit facility credentialing documents (if applicable).

2. Contracting & Payer Communication

Establish and maintain provider contracts with payers.

Follow up with payers regularly to ensure timely processing of applications.

Resolve contract discrepancies, panel closures, and credentialing denials.

Notify clients and internal teams about payer participation status and effective dates.

3. Recredentialing & Compliance

Manage recredentialing schedules and ensure no lapses occur.

Monitor expirations for licenses, certificates, malpractice insurance, and compliance documents.

Maintain provider directories and ensure accuracy across payer portals.

4. Client Communication & Documentation

Provide regular updates to clients regarding application status, payer timelines, and next steps.

Maintain detailed records and logs of all submissions, calls, and follow-ups.

Communicate clearly with non-technical staff and physicians to obtain missing documents.

Prepare credentialing reports for internal and client-facing meetings.

5. Cross-Team Collaboration

Work closely with Billing, Insurance Verification, Pre-Authorization, and Client Success teams to prevent delays in claims processing.

Notify RCM teams of effective dates, provider setups, taxonomies, and group affiliations.

Coordinate with IT teams for NPPES/NPI updates as needed.

Ideal Candidate Profile

Required Qualifications

• 2+ years of direct credentialing and enrollment experience

  in a healthcare environment
• (medical practice, RCM company, hospital, payer enrollment team, etc.)
• Strong understanding of

  Medicare, Medicaid, and commercial payer processes

• Experience managing CAQH, PECOS, NPPES

  , and payer portals
• Excellent communication skills—verbal, written, and client-facing
• Strong attention to detail and ability to manage multiple providers and deadlines
• Proficiency with spreadsheets and credentialing platforms

• Preferred Qualifications

• Experience with

  multiple specialties

  (Primary Care, Internal Medicine, Psychiatry, etc.)
• Knowledge of

  EHR setup

  and linking providers to groups
• Experience with contracting negotiation
• Prior work with an RCM or medical billing company
• Familiarity with

  HEDIS/quality programs

  and directory compliance

Soft Skills

• Highly organized with strong follow-up discipline
• Professional communication with physicians and administrators
• Ability to work independently and with a remote team
• Problem-solver who can navigate payer complexities
• Friendly, client-first attitude

Key Performance Indicators (KPIs)

• Credentialing application accuracy
• Timeliness of submissions
• Time-to-contract / time-to-approval
• Number of follow-ups completed
• On-time recredentialing rate
• Client satisfaction scores
• Minimal delays in billing due to credentialing issues

Compensation

Competitive salary (DOE)

Performance bonuses (optional)

Opportunity for promotion into Credentialing Manager as the team grows