Credentialing Specialist

2 to 3 years of hands-on medical credentialing or payer enrollment experience. Familiarity with CAQH, PECOS, payer portals, and credentialing software. Strong understanding of NCQA, TJC, CMS, and standard credentialing requirements. Track record of bringing order to complex or unstructured environments and building scalable processes. Ability to identify inconsistencies instantly and maintain clean, accurate files. Persistent and professional when gathering documentation or resolving gaps. Clear, concise, and confident written and verbal communication skills. Comfortable navigating multiple systems and adopting new tools. Ability to handle PHI and sensitive information with complete discretion. Process-driven, organized, proactive, resourceful, and committed to continuous improvement.

Own the full lifecycle of credentialing for physicians and advanced practice providers. Verify education, training, licenses, board certifications, malpractice insurance, and work history. Ensure credentialing files meet NCQA, TJC, CMS, and payer-specific requirements. Prepare, submit, and track enrollment applications with commercial payers, Medicare, and Medicaid. Manage CAQH ProView and process Medicare enrollments and updates through PECOS. Create structure in areas with few or inconsistent processes. Organize credentialing inputs into clear workflows, trackers, and checklists. Identify bottlenecks, design solutions, and implement improvements. Document processes and maintain updated SOPs. Collaborate with internal teams to keep workflows moving. Support account managers, operations, and revenue cycle teams. Partner with billing and AR teams to resolve claim denials. Maintain accurate provider data across CAQH, PECOS, payer portals, and internal systems. Own a master tracker for provider data. Keep credentialing records audit-ready. Monitor expiring state licenses, DEA registrations, malpractice insurance, and board certifications. Communicate proactively with providers for renewals.