Healthcare Credentialing & Payer Enrollment Specialist

Jobtailor

Englewood Cliffs (NJ)

On-site

USD 52,000 - 76,000

Full time

14 days+

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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