Job description
We are seeking a detail-oriented and experienced Credentialing Specialist to join our growing medical billing team. The Credentialing Specialist will be responsible for managing all aspects of provider credentialing and re-credentialing processes with insurance payers, hospitals, and medical groups. This role requires strong organizational skills, a deep understanding of healthcare credentialing requirements, and the ability to work independently in a remote setting.
Key Responsibilities:
Coordinate and complete initial and re-credentialing applications for healthcare providers.
Maintain current and accurate provider data in all systems and credentialing databases.
Monitor credentialing timelines to avoid lapses in privileges or payer enrollment.
Communicate with insurance companies, medical groups, and hospital credentialing departments to follow up on application statuses.
Assist with provider enrollments, group contracts, and insurance updates.
Provide regular updates and reports to leadership on credentialing status.
Resolve credentialing issues efficiently and professionally.
2+ years of experience in healthcare credentialing and payer enrollment (medical billing experience a plus).
Experience credentialing providers in California, Utah and Texas.
Knowledge of podiatry, primary care, or multi-specialty practices.
Strong knowledge of commercial insurance, Medicare, and Medi-Cal enrollment processes.
Familiarity with CAQH, PECOS, NPPES, and provider portals.
Excellent attention to detail and organizational skills.
Ability to manage multiple credentialing files and deadlines simultaneously.
Strong written and verbal communication skills.
Proficient in Microsoft Office Suite (Excel, Word, Outlook); experience with credentialing software preferred.
Self-motivated and capable of working remotely with minimal supervision.
High school diploma or GED required; associate or bachelor’s degree preferred.
