Credentialing specialist

Primary Responsibilities

• Own end-to-end provider credentialing and enrollment processes from onboarding through approval and ongoing maintenance, delivering a high-touch, white-glove provider experience
• Serve as the primary escalation point for complex credentialing issues, partnering with third-party vendor (Advantum) and insurance payors to drive timely resolution
• Manage consistent, professional communication with assigned providers across a portfolio of 50+ practice locations, ensuring alignment and responsiveness
• Oversee collection, validation, and ongoing maintenance of provider data and onboarding documentation to ensure accuracy, completeness, and compliance
• Maintain end-to-end visibility and accountability for enrollment progress, followups, and project initiatives through effective ticketing system management and tracking
• Ensure integrity, accuracy, and compliance of provider records and databases in accordance with internal standards and regulatory requirements
• Guide providers through credentialing and re-credentialing processes, proactively addressing inquiries and ensuring timely resolution of outstanding items
• Develop and maintain strong relationships with health plans and insurance payor representatives to support successful enrollment outcomes
• Partner cross-functionally with internal stakeholders, including:
• Revenue Cycle Management: Resolve billing issues related to credentialing status and enrollment gaps
• Payor Relations: Align on timely execution of payor contracts to support accurate enrollment submissions
• Proactively identify, analyze, and resolve enrollment gaps, delays, and risks impacting practice operations and revenue cycle performance
• Ensure strict compliance with all applicable state and federal regulations, including Medicare and Medicaid requirements
• Contribute to team initiatives focused on enrollment cleanup, process improvement, and operational efficiency
• Perform additional credentialing, compliance, and operational support duties as assigned

Minimum Qualifications / Requirements

• Minimum of 2 years of direct provider enrollment and credentialing experience required
• 2–3 years of administrative experience in a healthcare environment preferred
• Working knowledge of Medicare, Medicaid, and commercial payor enrollment processes
• Well versed within CAQH, NPPES, PECOS, and payor portals (e.g., Availity, One HealthCare ID, etc.)
• High School diploma or GED required (Associate’s or Bachelor’s degree preferred)
• Strong organizational skills with exceptional attention to detail
• Ability to manage multiple priorities, deadlines, and competing demands in a fast-paced environment
• Excellent communication, interpersonal, problem-solving, and critical thinking skills
• Ability to work independently with minimal supervision while maintaining accountability
• Comfortable working in a remote environment with video-based collaboration

Key Competencies

• Customer-focused with a high level of professionalism
• Strong follow-through and accountability
• Adaptability and resourcefulness in problem-solving
• Cross-functional collaboration and relationship-building
• Process-driven with a focus on accuracy and compliance