Credentialing Specialist

Key Skills Required:

• To manage and maintain the complete provider credentialing and re-credentialing process with payers, ensuring compliance with all regulatory and contractual requirements for smooth claim processing and revenue flow.
• To collect, verify, and update provider information (licenses, certifications, NPI, CAQH, DEA, malpractice insurance, etc.).
• To complete credentialing applications to add providers to commercial payers, Medicare, and Medicaid.
• Coordinate to collect required documents (licenses, certifications, CVs, insurance, signatures). Ensure timely submission and re-credentialing .Work jointly on new payer enrolments, group additions, and contract renewals to ensure providers are active in network. Provide credentialing status reports and resolve client escalations related to pending provider setups.
• To maintain individual provider files to include up to date information needed to complete the required federal and commercial payer credentialing applications.

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