Provider Credentialing & Enrollment Specialist

Capital Health (US); Lawrenceville (NJ); On-site; USD 28,000 - 36,000; Full time

Benefits offered by this job

Medical Plan

Dental Plan

Vision Plan

FSA

Retirement Savings

Paid Time Off

Employee Assistance Program

Commuter Benefits

Job summary

Capital Health is seeking a Credentialing Specialist to manage end-to-end credentialing and enrollment for providers across our network. You will serve as a strategic liaison between providers, insurance entities, and revenue cycle to ensure accurate, timely credentialing and enrollment, optimizing reimbursement.

Ideal candidates have at least 1 year of credentialing or related Revenue Cycle experience and strong attention to detail, with proficiency in credentialing software and Excel.

Qualifications

• Education: High school diploma or equivalency.
• Experience: 1 year provider credentialing/enrollment in a medical office; or 3 years Revenue Cycle experience in contracting, billing, registration or administration in a physician office or hospital.
• Knowledge/Skills: Effective communication, strong customer service, organization, accuracy, ability to handle high volume and work under pressure.
• Special Training: Windows-based processing, Excel spreadsheets, credentialing software; knowledge of payer requirements for credentialing/enrollment.

Responsibilities

• Maintain end-to-end credentialing and enrollment lifecycle.
• Audit provider files for regulatory compliance and data integrity.
• Coordinate with providers, payers and revenue cycle to optimize onboarding.
• Update and maintain data across multiple systems and health plans.
• Attach providers to group billing entities to ensure uninterrupted reimbursement.
• Prepare and review reports from payers to ensure timely revenue streams.
• Resolve enrollment issues with payers and internal teams.
• Manage timelines and documentation for provider onboarding.

Skills

Credentialing

Attention to detail

Communication

Customer service

Education

High school diploma or equivalent

Job description

Capital Health is seeking a Credentialing Specialist to manage end-to-end credentialing and enrollment for providers across our network. You will serve as a strategic liaison between providers, insurance entities, and revenue cycle to ensure accurate, timely credentialing and enrollment, optimizing reimbursement.

Ideal candidates have at least 1 year of credentialing or related Revenue Cycle experience and strong attention to detail, with proficiency in credentialing software and Excel.