Credentialing Specialist

Jobtailor; Englewood Cliffs (NJ); On-site; USD 52,000 - 76,000; Full time

Job summary

Jobtailor is seeking a Credentialing Specialist in Englewood Cliffs, NJ to manage credentialing and payer enrollment for providers across states. You will maintain CAQH profiles, update NPI records, and ensure timely revalidations while collaborating with Billing and Operations.

Ideal candidates have 2+ years of credentialing experience, strong attention to detail, and proficiency with Microsoft Office or Google Workspace.

Qualifications

• High school diploma or equivalent.
• At least two years of healthcare credentialing, provider enrollment, or payer enrollment experience.
• Hands-on experience with CAQH and the NPI Registry.
• Experience submitting applications to Medicaid and commercial insurance payers.
• Strong attention to detail and commitment to maintaining complete, accurate records.
• Ability to manage a high-volume workload with firm deadlines.
• Strong written and verbal communication skills.
• Effective problem-solving, follow-up, and organizational skills.
• Proficiency with Microsoft Office or Google Workspace, including spreadsheets.
• Ability to work independently while collaborating across departments.
• Preferred: Experience in behavioral health, applied behavior analysis, pediatric therapy, or a multi-site healthcare organization.
• Preferred: Experience with multi-state Medicaid enrollment and state-specific credentialing requirements.
• Preferred: Familiarity with payer rosters, revalidations, contracting documentation, or credentialing audits.

Responsibilities

• Complete initial credentialing, recredentialing, and payer enrollment applications for individual providers and applicable entities
• Enroll providers with Medicaid and commercial insurance plans based on payer and state requirements
• Research and maintain current knowledge of credentialing and enrollment requirements across assigned states
• Create and maintain accurate provider files, including licenses, certifications, education, employment history, attestations, and other required documentation
• Maintain CAQH profiles, including documentation updates and re-attestations
• Create and update National Provider Identifier (NPI) records when needed
• Complete payer revalidation and recredentialing requests within required deadlines
• Track applications from submission through approval and follow up with payers to address delays or missing information
• Maintain accurate records of payer applications, login credentials, approval dates, effective dates, and renewal requirements
• Identify missing, expired, or inconsistent provider information and coordinate timely resolution
• Communicate credentialing status, delays, risks, and next steps to leadership and internal partners
• Collaborate with Billing and Operations to support provider activation and accurate payer participation
• Assist with payer contracting documentation and credentialing audits as needed
• Protect confidential provider and organizational information

Skills

CAQH Proficiency

NPI Registry

Attention to Detail

Time Management

Communication Skills

Multitasking

Microsoft Office

Google Workspace

Education

High School Diploma or GED

Tools

CAQH

NPI Registry

Job description

• Complete initial credentialing, recredentialing, and payer enrollment applications for individual providers and applicable entities
• Enroll providers with Medicaid and commercial insurance plans based on payer and state requirements
• Research and maintain current knowledge of credentialing and enrollment requirements across assigned states
• Create and maintain accurate provider files, including licenses, certifications, education, employment history, attestations, and other required documentation
• Maintain CAQH profiles, including documentation updates and re-attestations
• Create and update National Provider Identifier (NPI) records when needed
• Complete payer revalidation and recredentialing requests within required deadlines
• Track applications from submission through approval and follow up with payers to address delays or missing information
• Maintain accurate records of payer applications, login credentials, approval dates, effective dates, and renewal requirements
• Identify missing, expired, or inconsistent provider information and coordinate timely resolution
• Communicate credentialing status, delays, risks, and next steps to leadership and internal partners
• Collaborate with Billing and Operations to support provider activation and accurate payer participation
• Assist with payer contracting documentation and credentialing audits as needed
• Protect confidential provider and organizational information

Requirements

• High school diploma or equivalent
• At least two years of healthcare credentialing, provider enrollment, or payer enrollment experience
• Hands-on experience with CAQH and the NPI Registry
• Experience submitting applications to Medicaid and commercial insurance payers
• Strong attention to detail and commitment to maintaining complete, accurate records
• Ability to manage a high-volume workload with competing priorities and firm deadlines
• Strong written and verbal communication skills
• Effective problem-solving, follow-up, and organizational skills
• Proficiency with Microsoft Office or Google Workspace, including spreadsheets
• Ability to work independently while collaborating effectively across departments
• Preferred: Experience in behavioral health, applied behavior analysis, pediatric therapy, or a multi-site healthcare organization
• Preferred: Experience with multi-state Medicaid enrollment and state-specific credentialing requirements
• Preferred: Familiarity with payer rosters, revalidations, contracting documentation, or credentialing audits

Core Competencies

Demonstrates expertise in healthcare credentialing and provider enrollment, with a strong focus on maintaining accurate records and compliance with payer requirements. Proficient in managing high-volume workloads while effectively communicating with internal partners and leadership.

Highest-signal resume keywords

• Healthcare Credentialing Experience
• Provider Enrollment
• CAQH Proficiency
• NPI Registry Management
• Attention to Detail

Hard Skills

• Credentialing Applications
• Payer Enrollment
• Medicaid Submission
• Record Maintenance
• Recredentialing
• Application Tracking
• Problem-Solving
• Organizational Skills
• Multi-State Enrollment
• Contracting Documentation

Soft Skills

• Strong Communication Skills
• Effective Collaboration
• Time Management

Industry Keywords

• Behavioral Health
• Pediatric Therapy
• Credentialing Audits
• Payer Roster
• Revalidations

Tools & Technologies

• Microsoft Office
• Google Workspace