Credentialing & Payer Enrollment Specialist

Foothills Neurology Company; Phoenix (AZ); On-site; USD 52,000 - 78,000; Full time

Job summary

Foothills Neurology Company seeks a Credentialing Specialist to manage provider credentialing, payer enrollment, and re-credentialing. This role ensures physicians, NPs, and PAs are enrolled with contracted plans to maintain uninterrupted reimbursement and compliance.

The ideal candidate is detail-oriented, self-motivated, and capable of managing multiple credentialing timelines with clear documentation and cross-department communication.

Qualifications

• High school diploma or equivalent required; Associate's or Bachelor's degree preferred.
• Minimum of 2 years credentialing and/or payer enrollment experience in healthcare.
• Knowledge of NCQA standards, CAQH, NPPES/PECOS, and credentialing software systems.
• Familiarity with CMS, commercial insurance, and Medicaid enrollment processes preferred.

Responsibilities

• Prepare and submit initial credentialing, re-credentialing, and payer enrollment applications for all providers and locations.
• Maintain up-to-date provider records, including licenses, DEA, NPI, board certifications, malpractice insurance, and CAQH profiles.
• Track expirations, renewals, and re-attestation deadlines to ensure compliance with payer requirements.
• Conduct primary source verification and maintain accurate digital credentialing files.
• Communicate with payers, providers, and internal departments to resolve enrollment issues.
• Coordinate with HR during provider onboarding and terminations to ensure timely credentialing actions.
• Collaborate with billing and revenue cycle teams to align enrollment with payer rosters and rules.
• Prepare regular status reports for leadership on pending applications and expirations.
• Support audits and payer correspondence as needed.
• Stay updated on managed care regulations and medical terminology to ensure best practices.

Skills

Detail orientation

Organization

Communication

Education

High school diploma or equivalent

Tools

Microsoft Office

CAQH software

Job description

Foothills Neurology Company seeks a Credentialing Specialist to manage provider credentialing, payer enrollment, and re-credentialing. This role ensures physicians, NPs, and PAs are enrolled with contracted plans to maintain uninterrupted reimbursement and compliance.

The ideal candidate is detail-oriented, self-motivated, and capable of managing multiple credentialing timelines with clear documentation and cross-department communication.