Payer Credentialing Specialist
New
K
knownwellHealthcare
RemoteFull-TimeMiddle
Salary55,000 - 70,000 USD per year
Apply NowOpens the employer's application page
Job Details
- Experience
- Minimum of 1 year of experience in provider credentialing and payer enrollment
Requirements
- Minimum of 1 year of experience in provider credentialing and payer enrollment, preferably in a multi-state medical group or healthcare organization.
- Strong ownership mindset with the ability to work independently in a remote environment.
- High level of accuracy and attention to detail, with a methodical approach to tracking applications, deadlines, and documentation.
- Reliable follow-through with the ability to spot potential delays early and communicate effectively.
- Direct and transparent communicator for interactions with providers, health plans, and internal teams.
- Excellent time management and the ability to juggle multiple credentialing tasks and deadlines simultaneously.
- Familiarity with CAQH, NPPES, and PECOS (preferred).
Responsibilities
- Manage end-to-end credentialing and recredentialing processes for new and existing providers, including verification of education, training, board certifications, and work history.
- Coordinate payer enrollment applications and updates to ensure timely processing and provider participation across commercial and government payers.
- Maintain accurate and up-to-date credentialing files and records in compliance with internal standards and regulatory requirements.
- Collaborate with providers, health plans, and internal departments to resolve any credentialing-related issues or delays.
- Track credentialing timelines and proactively follow up on outstanding applications or documentation.
- Ensure compliance with NCQA, CMS, state, and payer-specific regulations and standards.
- Participate in audits, surveys, and reporting related to provider credentialing and enrollment.
- Support cross-functional teams including clinical operations, revenue cycle, and human resources with credentialing-related information and processes.
View Full Description & ApplyYou'll be redirected to the employer's site
