Credentialing Specialist

HOME PHYSICIANS GROUP; Orlando (FL); On-site; USD 48,000 - 64,000; Full time

Job summary

Home Physicians Group is seeking a Credentialing Specialist to coordinate all aspects of provider credentialing, recredentialing, and payer enrollment in a fast-paced healthcare environment.

The ideal candidate will have 2+ years in credentialing or healthcare administration, experience with enrollment, and familiarity with CAQH, PECOS, and payer portals. This role supports audits and accreditation while maintaining provider files and records.

Qualifications

• Minimum 2 years in credentialing or healthcare administration.
• Experience with provider credentialing and payer enrollment.
• Familiarity with CAQH, PECOS, and payer portals preferred.

Responsibilities

• Coordinate initial credentialing and recredentialing for physicians and APPs.
• Complete and maintain provider enrollment with Medicare, Medicaid, and commercial plans.
• Monitor credential expiration dates, licenses, certifications, and malpractice coverage.
• Maintain accurate provider files and credentialing databases.
• Communicate with providers, payers, hospitals, facilities, and regulators regarding credentialing status.
• Ensure compliance with federal, state, payer, and organizational requirements.
• Assist with onboarding new providers and maintaining provider records.
• Support audits and accreditation activities as needed.

Skills

Credentialing experience

Healthcare administration

Provider enrollment

Communication

Education

Associate's or Bachelor's degree preferred

Tools

CAQH

PECOS

Payer portals

Job description

Home Physicians Group is seeking a detail-oriented and organized Credentialing Specialist to join our growing team. If you enjoy working in a fast-paced healthcare environment and have experience managing provider credentialing and enrollment, we'd love to hear from you!

Our company was founded in 2005 and we serve the Central Florida geriatric population across 14 counties.

Our Mission: We create a nurturing healthcare experience, empowering patients by providing a physician led ecosystem based on a foundation of Science, Technology, Faith, and Compassion.

Position Summary

The Credentialing Specialist is responsible for coordinating all aspects of provider credentialing, recredentialing, and payer enrollment to ensure our providers meet all regulatory, payer, and organizational requirements. The ideal candidate will also be responsible for maintaining the facility credentialing applications for providers.

Responsibilities

• Coordinate initial credentialing and recredentialing for physicians and advanced practice providers.
• Complete and maintain provider enrollment with Medicare, Medicaid, and commercial insurance plans.
• Monitor credential expiration dates, licenses, certifications, and malpractice coverage.
• Maintain accurate provider files and credentialing databases.
• Communicate with providers, payers, hospitals, facilities, and regulatory agencies regarding credentialing status.
• Ensure compliance with federal, state, payer, and organizational requirements.
• Assist with onboarding new providers and maintaining provider records.
• Support audits and accreditation activities as needed.

Qualifications

• High school diploma or GED required; Associate's or Bachelor's degree preferred.
• Minimum of 2 years of credentialing or healthcare administration experience preferred.
• Experience with provider credentialing, payer enrollment, or medical staff services.
• Knowledge of CAQH, PECOS, and insurance payer portals preferred.