Credentialing Specialist

Job Summary:

Credentialing Specialist

Key Responsibilities:

• Manage end-to-end

  provider credentialing and re-credentialing

  processes with commercial and government payers.
• Complete

  payer enrollment applications

  for Medicare, Medicaid, and private insurers.
• Maintain and update provider profiles in

  CAQH

  ,

  PECOS

  ,

  NPPES

  , and other relevant portals.
• Liaise with providers to obtain, verify, and validate all required documentation (licenses, certificates, malpractice insurance, etc.).
  
• Monitor and track

  credentialing expirations

  , license renewals, and re-attestation schedules.
• Work closely with billing and compliance teams to ensure timely payer setup and claims processing.
  
• Maintain accurate and up-to-date records in credentialing databases or software.
  
• Ensure compliance with

  HIPAA

  ,

  NCQA

  ,

  JCAHO

  , and payer-specific standards.
• Resolve enrollment issues and follow up on pending applications with payers and agencies.
  
• Communicate credentialing status to providers, management, and RCM teams.

Required Skills & Qualifications:

• Experience:

  2 -4 years of hands-on experience in credentialing from a

  provider office setting

  .
• Strong knowledge of:
  

• CAQH, PECOS, NPPES

• Medicare/Medicaid enrollment

• Commercial payer requirements and portals (e.g., Availity)
  
• Familiarity with RCM and its impact on credentialing.
  
• Proficiency in MS Office tools (Excel, Word, Outlook).
  
• Excellent verbal and written communication skills.
  
• Strong attention to detail and ability to manage multiple tasks.
  
• Understanding of credentialing compliance guidelines (HIPAA, NCQA, etc.).