Provider Credentialing Specialist

📋 Job Title: Provider Credentialing Specialist

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🏢 About RevGroMD

Insurance Credentialing

detail-oriented and process-driven Credentialing Specialist

🎯 Role Overview

Provider Credentialing Specialist

🔍 Key Responsibilities

✅ Prepare and submit credentialing and re-credentialing applications to commercial and government insurance payers (e.g., Medicare, Medicaid, BCBS, Aetna, Cigna, etc.).

CAQH

✅ Follow up proactively with payers to track application status and resolve delays.

✅ Communicate with clients/providers to obtain missing documents, signatures, or clarifications.

✅ Track and manage re-credentialing deadlines to ensure continued network participation.

✅ Update internal tracking systems and maintain detailed logs for every case.

✅ Collaborate with cross-functional teams to support seamless provider setup.

✅ Ensure 100% compliance with payer, state, and federal regulations.

📌 Qualifications & Skills

✔ 1+ years of experience in provider credentialing or healthcare operations (preferred).

✔ Strong knowledge of payer portals, credentialing processes, and enrollment guidelines.

✔ Familiarity with CAQH, PECOS, NPPES, and payer-specific platforms.

✔ Excellent written and verbal communication skills.

✔ Ability to manage multiple priorities, stay organized, and meet deadlines.

✔ Proficiency in Google Workspace or MS Office (Excel, Word).

✔ Strong attention to detail and problem-solving skills.

🌟 What We Offer

✨ Opportunity to work with a fast-growing startup

✨ Collaborative, supportive, and process-driven work environment

✨ Exposure to cross-functional projects in RCM, marketing & automation

✨ Skill development in a high-demand healthcare operations niche