Credentialing Specialist
New
E
ExpressableHealthcare
Remote in the United StatesFull-TimeMiddle
Salary22 - 27 USD per hour
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Job Details
- Required Skills
- Microsoft OfficeCompliance
Requirements
- 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
Responsibilities
- 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
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