Credentialing & Provider Enrollment Specialist

Judson Center; Farmington Hills (MI); On-site; USD 45,000 - 65,000; Full time

Job summary

Judson Center in Farmington Hills, MI is seeking a Credentialing Specialist to prepare, submit, and maintain enrollment, credentialing, and recredentialing documentation for providers. The role supports government payers and roster data, with a strong emphasis on accuracy and timely renewals.

The candidate will verify licenses and board certifications, manage provider data across CAQH, PECOS, NPPES, and Availity, and coordinate with payers to obtain in-network status.

Qualifications

• Associate degree or 2+ years related experience preferred; or 4+ years experience and training.
• CPCS certification preferred.
• Payer enrollment: 1 year preferred; Non-Profit: 1 year preferred.

Responsibilities

• Compile and maintain current data for all providers.
• Enter and maintain provider information in CAQH, PECOS, NPPES, Availity, and other systems.
• Verify State licenses, DEA, and Board certifications.
• Submit credentialing and recredentialing applications to payers.
• Audit applications for accuracy and completeness.
• Monitor application progress and follow up with payers until in-network status is achieved.
• Maintain copies of licenses, DEA certificates, and malpractice coverage; track expirations.

Skills

Credentialing knowledge

Data entry accuracy

Communication skills

Attention to detail

Independent worker

Time management

Education

Associate degree or 4 years experience

CPCS certification (preferred)

Tools

CAQH

PECOS

NPPES

Availity

Job description

Location: Farmington Hills, MI

Job Id:1656

# of Openings:1

Status: Full Time, Exempt

Reports to: Senior Manager of Quality and Corporate Compliance

*Michigan ON-SITE Candidates only*- Farmington Hills

Job Summary

The Credentialing Specialist is responsible for preparing, submitting, and maintaining enrollment, credentialing and recredentialing, documentation for providers, clinicians and other billable providers.

Primary Duties and Responsibilities

• Responsible for Compiling and maintaining current and accurate data for all providers
• Responsible for Data entry and maintaining provider information in online databases and systems (CAQH, PECOS, and NPPES, Availity and any other systems as required.)
• Responsible for Verification of State license, DEA, and Board certification
• Ensures all required documentation is presented to government payers to receive provisional status to practice and be eligible for reimbursement
• Responsible for Completing provider initial and recredentialing applications
• Audits applications for accuracy and completeness
• Responsible for revalidation requests issued by government payers
• Responsible for Submitting completed credentialing and re-credentialing applications and supporting documentation to all requested payers
• Compiles and maintains current data and master grid of all providers for agency roster
• Maintains knowledge of current agency, state, county, and payor requirements for credentialing
• Responsible for monitoring application progress and following up with necessary parties/payers as needed until confirmation of “in network” status has been received
• Responsible for monitoring and maintaining copies of current state licenses, DEA certificates, malpractice coverage and any other required credentialing documents for all providers. As well as tracking all state licenses, DEA, and board certification expirations for all providers to ensure timely renewal
• Responsible for sending monthly updates to supervisors, program leads, and providers/clinicians
• Utilizes strong research skills to gather pertinent information regarding providers
• Assists in compilation of documents for audits conducted by Regulatory Agencies
• Collaborates and executes Quality Assurance and Compliance Projects and Tasks as a Quality and Compliance Assistant including support of the Council of Accreditation Re-Credentialing Process and other related Quality and Compliance Administrative Tasks.
• Undertakes additional projects and responsibilities as assigned by management to support the overall goals of the organization
• All other duties as assigned

Qualifications

• Associate degree and a minimum of 2 years related experience preferred; or at least four years related experience and training
• Working knowledge of credentialing accreditation regulations, policies, and procedures
• Certified Professional Credentialing Specialist (CPCS) certification preferred
• Payer Provider Enrollment: 1 year (Preferred) Non-Profit: 1 year (Preferred)

Skills Required

• Familiar with provider credentialing and recredentialing requirements
• Strong analytic computer and software skills
• Excellent interpersonal skills including excellent verbal and written communication skills
• Ability to demonstrate a high degree of trust and confidentiality
• Ability to work independently and assume assigned responsibilities
• Skilled in efficiency, organization, time management, and prioritization
• Ability to be flexible and function well in a fast-paced environment
• Ability to communicate effectively and relate to people of diverse cultures
• Ability to handle confidential information

Working Conditions

• Able to sit and work at a computer for extended periods
• Able to lift and move up 15 pounds occasionally
• Flexible schedule required; Requires regular and on-time attendance

This description is intended to describe the type and level of work being performed by a person assigned to this job. It is not an exhaustive list of all duties and responsibilities of a person so classified. The employee is expected to adhere to all company policies and perform other duties as assigned for the good of the consumers, the program, the department and the agency.