Credentialing Specialist

• Maintain individual provider files to include up to date information needed to complete the required governmental and commercial payer credentialing applications
• Maintain accurate provider profiles on CAQH, NPPES and any other applicable profiles
• Complete credentialing applications to add current and new providers to commercial, Medicaid, and Medicare payers
• Work closely with current and onboarding providers to obtain all necessary information to complete the credentialing and enrollment process
• Audit provider information in various systems
• Follow up with payers as it relates to credentialing, enrollment, and demographic updates
• Research payer processes as it relates to credentialing, enrollment, and demographic updates
• Assist in identifying and resolving any denials or authorization issues related to provider credentialing

• High school diploma or equivalent required
• Hands-on experience completing and submitting credentialing and enrollment applications for commercial payers, medicaid, and medicare
• Experience maintaining provider files and ensuring compliance with payer and regulatory requirements
• Prior experience working directly with providers to collect, validate, and update credentialing information
• Familiarity with auditing provider data across multiple systems and resolving discrepancies
• Experience following up with payers regarding application status, re-credentialing, and demographic updates
• Exposure to denial resolution or authorization issues related to credentialing strongly preferred
• Proficiency with credentialing platforms and databases
• Strong working knowledge of payer credentialing and enrollment workflows
• Comfortable navigating payer portals and researching payer-specific requirements
• Experience with electronic document management and maintaining compliant provider files
• Proficient with standard office productivity and collaboration tools (Docs/Word, Sheets/Excel, email, shared drives, etc.)
• Eligible to work in the United States

Exposure to denial resolution or authorization issues related to credentialing strongly preferred

• Exceptional paid time off policies that encourage and support life balance, including a winter break
• 401k matching
• Health insurance options
• Company paid life, short-term disability, and long-term disability coverage
• Remote work environment