Credentialing Specialist

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Requirements:

• Bachelor's degree.
• 2+ years working in health plan enrollment is preferred.
• Experience credentialing across multiple states as well as across Commercial and Medicaid payors.
• Experience with state Medicaid enrollment is preferred.
• Experience with delegated credentialing is a plus.
• Work authorized in the United States and native or bilingual English proficiency.
• Familiarity with and willingness to use cloud-based communication software—Google Suite, Slack, Zoom, Dropbox, Salesforce.

Responsibilities:

• Complete health plan enrollment applications for group and individual submissions across Medicaid and Commercial payers.
• Communicate directly with providers to gather necessary information for credentialing application submissions.
• Ensure adherence to application requirements to guarantee all required information is submitted to health plans.
• Follow up on outstanding enrollments through phone, email, and portal to expedite provider enrollment approval.
• Monitor application progress and propose solutions for resolving credentialing delays and rejections.
• Track application progress and follow-ups directly in Salesforce.