Credentialing & Payer Enrollment Specialist

AndHealth LLC; Columbus, Northern (OH, KY); Hybrid; USD 45,000 - 65,000; Full time

Benefits offered by this job

Medical Insurance

Dental Insurance

Vision Insurance

Paid time off

Job summary

AndHealth LLC in Columbus, OH is seeking a dedicated Credentialing Specialist to manage payer enrollment and credentialing processes for licensed healthcare professionals. You will collaborate with internal teams and external partners to ensure compliance, accuracy, and high-quality patient care.

Responsibilities include leading enrollment activities, tracking statuses, preparing reports, and maintaining documentation.

Qualifications

• Bachelor’s degree is preferred.
• 2+ years of experience credentialing in healthcare credentialing or related role.
• Experience with credentialing under FQHC and HRSA standards is a plus.
• Impeccable attention to detail and professionalism.

Responsibilities

• Lead payer enrollment activities for AndHealth’s partners, ensuring timely and accurate submission of all payer enrollment documents to partners.
• Accurately input and track payer enrollment statuses for all partners, maintaining comprehensive records for all activities.
• Prepare and distribute reports on enrollment status and credentialing activities for internal use and external audits.
• Establish and maintain effective communication with payer representatives and AndHealth’s partners to resolve any issues related to enrollment and credentialing.
• Create and maintain internal guides outlining payer enrollment processes and best practices.
• Gain an in-depth understanding of the payer landscape in states where we are doing business, with emphasis on Medicaid and the broader payer mix.
• Support ongoing education and training of AndHealth staff regarding payer enrollment requirements and landscapes in states where we are doing business.
• Maintain a highly organized system, including tracking mechanisms, for credentialing schedules, files, and documentation.
• Provide periodic updates to Credentialing Lead and respective AndHealth teams on credentialing and payer enrollment statuses.
• Assist the Credentialing Lead in all credentialing-related activities for partners, including primary source verifications, license renewals, CAQH profile updates, and preparation of credentialing and re-credentialing applications for AndHealth providers, clinical pharmacists, pharmacy team members and other non-clinical staff.
• Maintain knowledge of current partners, government agencies, and general requirements for credentialing AndHealth professionals.
• Collaborate with legal and compliance to ensure adherence to laws, regulations, and contractual obligations related to credentialing, licensure and payer enrollment.
• Participate in internal partner meetings and external partner meetings to obtain updates on payer enrollment related activities.
• Assist with special projects as needed.

Skills

Attention to detail

Interpersonal skills

Verbal communication

Written communication

Organizational skills

Independent worker

Adaptability

Education

Bachelor’s degree required

Tools

Microsoft Office

Google Workspace

Credentialing software

Database systems

Job description

AndHealth LLC in Columbus, OH is seeking a dedicated Credentialing Specialist to manage payer enrollment and credentialing processes for licensed healthcare professionals. You will collaborate with internal teams and external partners to ensure compliance, accuracy, and high-quality patient care.

Responsibilities include leading enrollment activities, tracking statuses, preparing reports, and maintaining documentation.