Remote Credentialing Specialist — Healthcare Providers

nimble solutions; Chesterfield (MO); On-site; USD 52,000 - 78,000; Full time

Job summary

nimble solutions is seeking a Credentialing Specialist to support provider credentialing and payer enrollment functions for multiple healthcare clients within the RCM space. The role ensures providers are accurately credentialed and enrolled with Medicare, Medicaid, and commercial plans to prevent denials and optimize reimbursement.

The successful candidate will collaborate with providers, payers, and internal teams, maintain compliant records, and stay updated on CMS/NCQA standards to ensure

Qualifications

• Associate's or Bachelor's degree preferred (Healthcare Administration or related field).
• Minimum 2 years of credentialing or provider enrollment experience, preferably with an RCM vendor or multi-client environment.
• Familiarity with Medicare/Medicaid enrollment processes, PECOS, CAQH, and payer portals.

Responsibilities

• Manage end-to-end credentialing and recredentialing for providers across assigned client accounts.
• Prepare, submit, and track payer enrollment and participation applications for Medicare, Medicaid, and commercial health plans.
• Verify provider credentials, including licenses, NPI, DEA, malpractice, CAQH profiles, and board certifications.
• Maintain detailed, organized records of all credentialing activities within internal databases and client systems.
• Communicate with providers, payers, and internal teams to resolve credentialing issues or delays.
• Proactively monitor upcoming expirations and initiate timely renewals to ensure continuous network participation.
• Collaborate with the contracting and billing teams to align provider enrollment with payer contracts and claim submission readiness
• Stay current with payer policies, CMS, and NCQA credentialing standards to ensure compliance
• Generate credentialing status reports and provide updates to internal leadership and client contacts

Skills

Communication

Organization

Multitasking

Microsoft Office

Education

Healthcare Administration degree

Tools

Credentialing software

Payer portals

Job description

nimble solutions is seeking a Credentialing Specialist to support provider credentialing and payer enrollment functions for multiple healthcare clients within the RCM space. The role ensures providers are accurately credentialed and enrolled with Medicare, Medicaid, and commercial plans to prevent denials and optimize reimbursement.

The successful candidate will collaborate with providers, payers, and internal teams, maintain compliant records, and stay updated on CMS/NCQA standards to ensure