Provider Credentialing & Network Enrollment Lead

CenterLight Health System; New York (NY); On-site; USD 75,000 - 85,000; Full time

Job summary

CenterLight Health System is seeking a Provider Credentialing Specialist to manage the full lifecycle of provider credentialing, enrollment, and payer network participation for TeamCare Medical providers and locations.

You will coordinate CAQH/NPPES/PECOS activities, maintain credentialing documentation, and serve as the liaison between providers, carriers, practice managers, and Finance to ensure timely credentialing and successful payer enrollment.

Qualifications

• Bachelor's degree or equivalent years of experience in healthcare administration or related field.
• At least 3 years of healthcare credentialing, enrollment, or payer relations experience.
• Experience with Medicare, Medicaid, and commercial carriers is required.

Responsibilities

• Manage full lifecycle credentialing, recredentialing, and payer enrollment for providers and licensed professionals.
• Prepare, submit, and track credentialing applications with commercial carriers, Medicare, and Medicaid.
• Submit enrollment and revalidation for Medicare using PECOS.
• Monitor statuses to ensure timely provider participation and renewals.
• Maintain provider records, licenses, and malpractice documentation related to credentialing.
• Coordinate CAQH, license updates, and re-attestations with regulators.
• Coordinate enrollment for new clinics and locations with payers and networks.
• Develop relationships with insurance representatives and provider relations teams to support enrollment.
• Prepare reports on credentialing activities and timelines for leadership.
• Assist in audits and process improvements to reduce enrollment delays.

Skills

Healthcare credentialing

Provider enrollment

Payer relations

Medical practice administration

Project management

Education

Bachelor's degree in Healthcare Administration, Business Administration, Public Health, or equivalent years of experience

Tools

CAQH

PECOS

NPPES

Medicaid portals

Job description

CenterLight Health System is seeking a Provider Credentialing Specialist to manage the full lifecycle of provider credentialing, enrollment, and payer network participation for TeamCare Medical providers and locations.

You will coordinate CAQH/NPPES/PECOS activities, maintain credentialing documentation, and serve as the liaison between providers, carriers, practice managers, and Finance to ensure timely credentialing and successful payer enrollment.