Credentialing Specialist

We are seeking a detailoriented and experienced Credentialing Specialist to join our growing medical billing team. The Credentialing Specialist will be responsible for managing all aspects of provider credentialing and recredentialing processes with insurance payers, hospitals, and medical groups. This role requires strong organizational skills, a deep understanding of healthcare credentialing requirements, and the ability to work independently in a remote setting.

Key Responsibilities:

• Coordinate and complete initial and recredentialing applications for healthcare providers.
• Maintain current and accurate provider data in all systems and credentialing databases.
• Monitor credentialing timelines to avoid lapses in privileges or payer enrollment.
• Communicate with insurance companies, medical groups, and hospital credentialing departments to follow up on application statuses.
• Assist with provider enrollments, group contracts, and insurance updates.
• Provide regular updates and reports to leadership on credentialing status.
• Resolve credentialing issues efficiently and professionally.

• Requirements

  • 2+ years of experience in healthcare credentialing and payer enrollment (medical billing experience a plus).
  • Experience credentialing providers in California, Utah and Texas.
  • Knowledge of podiatry, primary care, or multispecialty practices.
  • Strong knowledge of commercial insurance, Medicare, and MediCal enrollment processes.
  • Familiarity with CAQH, PECOS, NPPES, and provider portals.
  • Excellent attention to detail and organizational skills.
  • Ability to manage multiple credentialing files and deadlines simultaneously.
  • Strong written and verbal communication skills.
  • Proficient in Microsoft Office Suite (Excel, Word, Outlook); experience with credentialing software preferred.
  • Selfmotivated and capable of working remotely with minimal supervision.
  • High school diploma or GED required; associate or bachelor’s degree preferred.