Credentialing Coordinator

Solve IT Strategies, Inc.; Pennsylvania; On-site; USD 30,000 - 47,000; Full time

Job summary

Solve IT Strategies, Inc. seeks an experienced Provider Credentialing Specialist to support credentialing and payer enrollment for healthcare providers.

You will process applications, maintain records, and ensure timely enrollment with commercial and government payers. The ideal candidate has at least 2 years in credentialing, hands-on experience with CAQH, Cactus, and MD-Staff, and strong attention to detail.

Qualifications

• High School Diploma or GED required.
• Minimum 2 years of provider credentialing or payer enrollment experience.
• Hands-on experience processing credentialing and enrollment applications.
• Behavioral health credentialing experience is highly desirable.
• Experience with credentialing databases and payer portals.

Responsibilities

• Process initial credentialing, payer enrollment, recredentialing, and revalidation applications.
• Collect, review, and verify provider documentation required for payer enrollment.
• Prepare, submit, and quality-check applications for completeness and accuracy.
• Follow up with providers and insurance payers to resolve missing documentation and deficiencies.
• Perform credentialing verification activities and background queries per policy.
• Maintain provider records across credentialing databases, CAQH, and payer portals.
• Review and validate provider data for accuracy and consistency.
• Identify duplicates or incomplete records and coordinate corrections.
• Monitor expirables, enrollment statuses, and revalidation deadlines.
• Communicate with providers, practice representatives, payer contacts, and internal teams.
• Provide credentialing updates and reporting to support operations and billing.
• Maintain confidentiality and adhere to privacy and quality standards.

Skills

Credentialing databases

Provider management systems

Payer portals

CAQH

Cactus

MD-Staff

Data entry

Record maintenance

Attention to detail

Organizational skills

Communication skills

Confidential data handling

Education

High School Diploma or GED

Tools

Cactus

MD-Staff

CAQH

Job description

We are seeking an experienced Provider Credentialing Specialist to support provider credentialing and payer enrollment operations. This individual will be responsible for hands‑on processing of provider applications, maintaining accurate credentialing records, and ensuring timely enrollment and participation with commercial and government payers.

The ideal candidate will have direct experience managing the end‑to‑end credentialing and enrollment process, preferably within a behavioral health or healthcare setting. Experience working with credentialing databases and supporting data integrity initiatives or system transitions is highly desirable.

Please Note: This is a contract opportunity with the potential to be considered for future permanent openings, should opportunities become available. Permanent placement is not guaranteed.

Required Qualifications

Education

• High School Diploma or GED required.

Experience

• Minimum of 2 years of relevant provider credentialing or payer enrollment experience.
• Direct, hands‑on experience processing provider credentialing and enrollment applications strongly preferred.
• Behavioral health credentialing or enrollment experience highly desirable.

Technical Skills

• Proficiency with credentialing databases, provider management systems, and payer portals.
• Experience with Cactus, MD-Staff, CAQH, or comparable credentialing platforms preferred.
• Strong computer, data entry, and record maintenance skills.

Additional Qualifications

• Exceptional attention to detail and organizational skills.
• Ability to independently manage workloads, deadlines, and multiple applications.
• Strong written and verbal communication skills.
• Ability to handle confidential provider information appropriately.

Preferred Experience

• Independently managing the full payer enrollment process, including application preparation, submission, follow‑up, deficiency resolution, and ongoing maintenance.
• Credentialing and enrollment of behavioral health providers.
• Experience with commercial insurance, Medicare, and Medicaid enrollment requirements.
• Credentialing database cleanup, data validation, record reconciliation, and quality assurance.
• Hands‑on experience with Cactus, MD‑Staff, or similar credentialing systems.
• Initial credentialing, recredentialing, primary source verification, and NPDB queries.
• CAQH profile management and re‑attestation.
• Medicare and Medicaid revalidation processes.
• Supporting credentialing database updates, conversions, or system transitions.

Key Responsibilities

• Process and monitor initial credentialing, payer enrollment, recredentialing, and revalidation applications.
• Collect, review, and verify provider documentation required for payer enrollment.
• Prepare, submit, and quality‑check applications for completeness and accuracy.
• Follow up with providers and insurance payers to resolve missing documentation, discrepancies, and application deficiencies.
• Perform credentialing verification activities and required background queries in accordance with established policies.
• Maintain and update provider records across credentialing databases, CAQH, and payer portals.
• Review, cleanse, and validate provider data to ensure accuracy, completeness, and consistency.
• Identify duplicate, outdated, incomplete, or inconsistent records and coordinate necessary corrections.
• Monitor credentialing expirables, payer enrollment statuses, recredentialing deadlines, and revalidation requirements.
• Maintain accurate documentation and status tracking throughout the credentialing lifecycle.
• Communicate with providers, practice representatives, payer contacts, and internal departments to facilitate timely enrollment.
• Provide credentialing updates and reporting to support operational and billing functions.
• Assist with resolving enrollment-related discrepancies impacting provider participation or claims processing.
• Maintain confidentiality and adhere to applicable privacy, compliance, and quality standards.
• Perform additional related duties as assigned.