Credentialing Specialist
New
M
Metro Vein CentersHealthcare
This is a remote roleFull-TimeMiddle
Salary not disclosed
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Job Details
- Experience
- 2+ years
- Required Skills
- Microsoft ExcelGoogle Sheets
Requirements
- 2+ years in provider credentialing and/or payer enrollment in a physician group, MSO, health plan, or hospital environment.
- Hands-on experience with CAQH (attestations/rosters), Medicare PECOS, and payer portals (e.g., Availity).
- Working knowledge of Medicare/Medicaid and commercial enrollment rules.
- Proficient in credentialing systems (e.g., MD-Staff/Cactus) and Excel/Google Sheets.
- Strong data accuracy and documentation habits for maintaining records across multiple systems.
- Effective written and verbal communication skills for interacting with payers, providers, and stakeholders.
- Proven ability to prioritize tasks in a high-volume environment and follow SOPs with minimal supervision.
- Self-starter mindset with strong ownership and follow-through in a remote setting.
- High school diploma or equivalent.
Responsibilities
- Submit and track provider enrollments across Medicare/Medicaid (PECOS) and commercial payers to secure effective dates.
- Identify network expansion opportunities by enrolling providers into additional payer products, plans, and service locations.
- Maintain CAQH attestations and accurate provider data across payer portals and internal credentialing systems.
- Monitor re-validations/re-credentialing and manage expirables to prevent participation lapses.
- Assist with onboarding new providers: gather documents, set up NPI/taxonomy/locations, and coordinate start-date readiness.
- Respond to payer requests, supply additional documentation, and resolve application issues promptly.
- Escalate concerns and complex cases to the Supervisor of Credentialing and participate in special projects.
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