Credentialing Specialist: Payer Enrollment & Compliance

Central City Health, Inc.; Detroit (MI); On-site; USD 47,000 - 75,000; Full time

Job summary

Central City Health, Inc. is seeking a Credentialing Specialist to manage all aspects of provider credentialing, including initial appointments, reappointments, credential audits, and clinical privileging for Medical Staff and Allied Health Professionals.

You will also support payer enrollment and related compliance activities, ensuring accurate credentialing records and timely renewals across the organization in Detroit, MI, with collaboration across departments.

Qualifications

• 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 are strongly preferred.

Responsibilities

• The Credentialing Specialist is responsible for facilitating all aspects of provider credentialing, including initial appointment and reappointment, credential audits, and clinical privileging for Medical Staff, Allied Health Professionals, and all other staff within Central City Health.
• The Credentialing Specialist will also support payer enrollment and related compliance activities.

Skills

Credentialing

Provider enrollment

Tools

PECOS

NPPES

CAQH

Medicare

Medicaid

Payer enrollment portals

Microsoft Office

Job description

Central City Health, Inc. is seeking a Credentialing Specialist to manage all aspects of provider credentialing, including initial appointments, reappointments, credential audits, and clinical privileging for Medical Staff and Allied Health Professionals.

You will also support payer enrollment and related compliance activities, ensuring accurate credentialing records and timely renewals across the organization in Detroit, MI, with collaboration across departments.