Provider Credentialing & Enrollment Specialist

Physicians Practice Enhancement Llc; Red Bank (NJ); On-site; USD 52,000 - 76,000; Full time

Job summary

Physicians Practice Enhancement Llc in Red Bank, NJ is seeking a detail-oriented Credentialing Specialist to manage provider credentialing, payer enrollment, and recredentialing, ensuring timely and accurate processes in compliance with regulations.

You will coordinate documentation, use PECOS and CAQH, submit NPDB reports, and handle audits while maintaining accurate records and responsive communication with providers and insurers.

Qualifications

• High school diploma or equivalent.
• Strong organizational skills with exceptional attention to detail.
• Proficiency in Microsoft Office applications, including Excel, Word, and Outlook.
• Excellent written and verbal communication skills.

Responsibilities

• Coordinate and perform provider credentialing and recredentialing activities.
• Monitor and maintain credentialing documentation, including licensure, board certifications, malpractice coverage, and other required credentials.
• Utilize PECOS, CAQH, and other credentialing systems to manage provider data, generate reports, and maintain records.
• Submit and retrieve NPDB reports in accordance with applicable regulations.
• Complete payer enrollment and credentialing applications for physicians, advanced practice providers, facilities, and other healthcare professionals.
• Manage provider recredentialing processes and ensure timely renewals.
• Maintain and update credentialing software and databases.
• Collect, organize, and maintain accurate provider documentation and files.
• Conduct follow-up with providers, clients, and insurance carriers to ensure timely processing of credentialing and enrollment applications.
• Communicate effectively with providers and insurance representatives regarding credentialing and enrollment status.
• Review and update health plan directories and other applicable databases to ensure provider information remains accurate.
• Assist with audits, compliance reviews, and special projects as assigned.
• Perform other duties as assigned.

Skills

Detail oriented

Organizational skills

Written and verbal communication

Education

High school diploma or equivalent

Tools

PECOS

CAQH

NPDB

Job description

Physicians Practice Enhancement Llc in Red Bank, NJ is seeking a detail-oriented Credentialing Specialist to manage provider credentialing, payer enrollment, and recredentialing, ensuring timely and accurate processes in compliance with regulations.

You will coordinate documentation, use PECOS and CAQH, submit NPDB reports, and handle audits while maintaining accurate records and responsive communication with providers and insurers.