Credentialing Specialist

Summary

Join our growing medical billing team as a Credentialing Specialist, where you will manage 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.

Requirements

• 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

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