Healthcare Credentialing Specialist

Valid8 Financial, Inc.; Boston (MA); On-site; USD 46,000 - 60,000; Full time

Benefits offered by this job

Competitive pay

Professional growth

Continuing education

Job summary

New Horizon Billing Solutions (NHBS) seeks a Medical Credentialing Specialist to manage credentialing, re-credentialing and payer enrollment for healthcare providers. You will verify licenses, maintain provider data in CAQH, NPPES and PECOS, and ensure compliance with payer requirements.

You will be the primary contact for credentialing status, coordinate provider and TIN linkage to payer portals, and support audits.

Qualifications

• Strong attention to detail and organizational skills required.
• Excellent written and verbal communication with providers and payers.
• Ability to manage multiple priorities in a fast-paced environment.

Responsibilities

• Process initial credentialing and re-credentialing applications for physicians and other licensed professionals.
• Perform primary source verification of education, licensure, board certification, and other credentials.
• Maintain provider files in CAQH, NPPES, and PECOS; submit packets to payers and track approvals.
• Coordinate linkage of providers to payer portals for claims submission and prior auth access.

Job description

New Horizon Billing Solutions (NHBS) seeks a Medical Credentialing Specialist to manage credentialing, re-credentialing and payer enrollment for healthcare providers. You will verify licenses, maintain provider data in CAQH, NPPES and PECOS, and ensure compliance with payer requirements.

You will be the primary contact for credentialing status, coordinate provider and TIN linkage to payer portals, and support audits.