Credentialing Specialist

Staff4Me; United States; Remote; USD 40,000 - 80,000; Full time

Job summary

An established industry player in medical billing is on the lookout for a detail-oriented Credentialing Specialist. This pivotal role involves managing provider credentialing processes, ensuring compliance with insurance payers, and maintaining accurate data. The ideal candidate will thrive in a remote setting, showcasing strong organizational skills and a deep understanding of healthcare credentialing. If you're self-motivated and passionate about making a difference in healthcare, this opportunity is perfect for you!

Qualifications

• 2+ years of experience in healthcare credentialing and payer enrollment.
• Strong knowledge of commercial insurance and Medicare enrollment processes.

Responsibilities

• Coordinate and complete initial and re-credentialing applications for healthcare providers.
• Maintain accurate provider data in credentialing databases.

Skills

Healthcare Credentialing

Organizational Skills

Communication Skills

Attention to Detail

Problem-Solving

Education

High School Diploma or GED

Associate or Bachelor’s Degree

Tools

Microsoft Office Suite

Credentialing Software

Job description

We are seeking a detail-oriented and experienced Credentialing Specialist to join our growing medical billing team. The Credentialing Specialist will be responsible for managing all aspects of provider credentialing and re-credentialing processes with insurance payers, hospitals, and medical groups. This role requires strong organizational skills, a deep understanding of healthcare credentialing requirements, and the ability to work independently in a remote setting.

Key Responsibilities:

· Coordinate and complete initial and re-credentialing applications for healthcare providers.

· Maintain current and accurate provider data in all systems and credentialing databases.

· Monitor credentialing timelines to avoid lapses in privileges or payer enrollment.

· Communicate with insurance companies, medical groups, and hospital credentialing departments to follow up on application statuses.

· Assist with provider enrollments, group contracts, and insurance updates.

· Provide regular updates and reports to leadership on credentialing status.

· Resolve credentialing issues efficiently and professionally.

· 2+ years of experience in healthcare credentialing and payer enrollment (medical billing experience a plus).

· Strong knowledge of commercial insurance, Medicare, and Medi-Cal enrollment processes.

· Familiarity with CAQH, PECOS, NPPES, and provider portals.

· Excellent attention to detail and organizational skills.

· Ability to manage multiple credentialing files and deadlines simultaneously.

· Strong written and verbal communication skills.

· Proficient in Microsoft Office Suite (Excel, Word, Outlook); experience with credentialing software preferred.

· Self-motivated and capable of working remotely with minimal supervision.

· High school diploma or GED required; associate or bachelor’s degree preferred.

Preferred:

· Experience credentialing providers in California, Utah and Texas.

· Knowledge of podiatry, primary care, or multi-specialty practices.