Credentialing Specialist

Central City Health; Detroit (MI); On-site; USD 25,000 - 41,000; Full time

Job summary

Central City Health in Detroit is seeking an experienced Provider Credentialing & Enrollment Associate to support credentialing, recredentialing, payer enrollment, and related compliance activities.

You will coordinate initial appointments, manage CAQH/NPI tasks, monitor license expirations, and communicate with payers to resolve enrollment issues. This in-person role offers a collaborative team environment and opportunities to improve internal credentialing processes.

Qualifications

• Minimum of three (3) years of recent experience credentialing individual healthcare providers and facilities.
• Experience with PECOS, NPPES, CAQH, Medicare, Medicaid, managed care organizations, and commercial payer enrollment processes.
• Proficiency with Microsoft Office applications.
• Experience working with healthcare databases and payer or clearinghouse portals.
• Experience tracking professional license and certification expiration dates strongly preferred.

Responsibilities

• Coordinate and maintain provider credentialing and recredentialing activities, including initial appointments and clinical privileging.
• Process credentialing documentation for newly hired and rehired providers.
• Maintain accurate and current provider credentialing files and supporting documentation.
• Complete and monitor governmental and commercial payer enrollment and credentialing applications.
• Maintain credentialing and enrollment tracking systems to monitor application status, effective dates, renewals, and outstanding requirements.
• Follow up with Medicare, Medicaid, managed care organizations, commercial health plans, and other payers throughout the credentialing and enrollment process.
• Maintain and update provider information in CAQH and other applicable credentialing and enrollment systems.
• Assist providers with National Provider Identifier (NPI) applications, when applicable.
• Monitor professional licenses, certifications, credentials, and other required documentation for expiration and renewal.
• Support organizational compliance with applicable credentialing, regulatory, and accreditation requirements.
• Process payer disenrollment when providers separate from the organization.
• Communicate with providers, internal stakeholders, payers, and external organizations to resolve credentialing and enrollment issues.
• Assist with maintaining and improving internal credentialing processes.
• Perform other related duties as assigned.

Skills

Credentialing experience

Payer enrollment

Microsoft Office

PECOS

NPPES

CAQH

Documentation management

Job description

Job Summary

A well-established healthcare organization in the Detroit area is seeking an experienced Provider Credentialing & Enrollment Associate to support provider credentialing, recredentialing, payer enrollment, and related compliance activities.

Responsibilities

• Coordinate and maintain provider credentialing and recredentialing activities, including initial appointments and clinical privileging.
• Process credentialing documentation for newly hired and rehired providers.
• Maintain accurate and current provider credentialing files and supporting documentation.
• Complete and monitor governmental and commercial payer enrollment and credentialing applications.
• Maintain credentialing and enrollment tracking systems to monitor application status, effective dates, renewals, and outstanding requirements.
• Follow up with Medicare, Medicaid, managed care organizations, commercial health plans, and other payers throughout the credentialing and enrollment process.
• Maintain and update provider information in CAQH and other applicable credentialing and enrollment systems.
• Assist providers with National Provider Identifier (NPI) applications, when applicable.
• Monitor professional licenses, certifications, credentials, and other required documentation for expiration and renewal.
• Support organizational compliance with applicable credentialing, regulatory, and accreditation requirements.
• Process payer disenrollment when providers separate from the organization.
• Communicate with providers, internal stakeholders, payers, and external organizations to resolve credentialing and enrollment issues.
• Assist with maintaining and improving internal credentialing processes.
• Perform other related duties as assigned.

Requirements

• Minimum of three (3) years of recent experience credentialing individual healthcare providers and facilities required.
• Demonstrated experience with healthcare credentialing and provider enrollment.
• Working knowledge of PECOS, NPPES, CAQH, Medicare, Medicaid, managed care organizations, and commercial payer enrollment processes.
• Experience working with healthcare databases and payer or clearinghouse portals.
• Proficiency with Microsoft Office applications.
• Experience tracking professional license and certification expiration dates strongly preferred.

Join us in a role that empowers you to ensure seamless provider onboarding while supporting our mission of delivering exceptional healthcare services! We value your expertise in healthcare compliance and your dedication to maintaining the highest standards of professionalism in every task you undertake.

Pay: Up to $30.00 per hour

Work Location: In person