Provider Enrollment Specialist - Credentialing

RiseMe; Red Bank (NJ); On-site; USD 60,000 - 80,000; Full time

Job summary

RiseMe is seeking a detail-oriented Credentialing Specialist to manage provider credentialing, payer enrollment, and recredentialing. You will ensure timely and accurate credentialing in compliance with regulatory requirements and maintain updated records across systems.

The role requires strong organizational skills, proficient MS Office use, and experience with CAQH, PECOS, NPDB, and credentialing software.

Qualifications

• High school diploma or equivalent.
• Associate degree or higher preferred in related field.
• Experience with provider credentialing, payer enrollment, or healthcare administration is a plus.
• Familiarity with CAQH, PECOS, NPDB, and credentialing software platforms.

Responsibilities

• Coordinate and perform provider credentialing and recredentialing activities.
• Monitor and maintain credentialing documentation and licenses.
• Submit and retrieve NPDB reports and manage payer enrollment applications.
• Maintain credentialing software and databases and ensure timely renewals.
• Communicate status with providers, insurance carriers, and clients.

Skills

Organizational skills

Attention to detail

MS Office

Communication

Education

Associate degree

Tools

CAQH

PECOS

NPDB

Credentialing software

Job description

We are seeking a detail-oriented and highly organized Credentialing Specialist to join our team. This position is responsible for managing all aspects of provider credentialing, payer enrollment, recredentialing, and related administrative functions. The ideal candidate will ensure providers are credentialed and enrolled accurately and timely while maintaining compliance with payer, regulatory, and accreditation requirements.

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 National Practitioner Data Bank (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.

Qualifications

Required

• 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.

Preferred

• Associate degree or higher in Business Administration, Healthcare Administration, or a related field.
• Previous experience in provider credentialing, payer enrollment, medical staff services, healthcare administration, or related healthcare operations.
• Working knowledge of credentialing regulations, accreditation standards, and insurance payer requirements.
• Experience with CAQH, PECOS, NPDB, and credentialing software platforms.

What We're Looking For

The successful candidate will demonstrate:

• Strong analytical and problem-solving abilities.
• Ability to manage multiple priorities and deadlines.
• A commitment to accuracy, confidentiality, and customer service.
• Ability to work independently and collaboratively within a team environment.

Job Type: Full-Time