Strategic Credentialing & Payer Enrollment Specialist

Nobleclinics; Manitowoc (WI); On-site; USD 42,000 - 60,000; Full time

Benefits offered by this job

20 days PTO (accrual starts on day one

8 paid holidays

401(k) with up to 5% employer match

Medical, dental, and vision insurance

Employer paid Short- and long-term(dis

disability and life insurance

Job summary

Noble Community Clinics is seeking a Credentialing Specialist to join our team in Manitowoc, WI. This role ensures providers and clinic sites stay enrolled with payers, manages contracting, revalidations, and related credentialing activities.

The position requires strong organizational, analytical, and communication skills, with experience in payer enrollment and familiarity with CAQH and Credential Stream. CPR certification within six months is required.

Qualifications

• High school diploma or equivalent required.
• Previous payer enrollment, credentialing, or payer contracting experience preferred.
• Strong computer skills, including proficiency with Microsoft Office applications required.
• Excellent organizational skills and attention to detail.
• Strong analytical and problem-solving abilities.
• Excellent time management skills and the ability to meet deadlines.
• Strong interpersonal and communication skills.
• CPR certification required within six months of hire.

Responsibilities

• Complete enrollment for new providers with applicable insurance payers and clearinghouses in a timely and accurate manner.
• Utilize Credential Stream to maintain, track, submit, and initiate provider enrollment and demographic information.
• Maintain CAQH proxy access on behalf of providers.
• Track provider, site, and contract renewals and expiration dates to prevent enrollment lapses.
• Coordinate payer revalidations, renewals, and enrollment updates.
• Establish and maintain professional relationships with insurance payer contacts.
• Serve as an organizational contact for payer enrollment and contracting questions and issues.
• Research payer requirements and develop guidelines for new provider and site agreements as needed.
• Monitor payer requirements and communicate changes to appropriate internal departments.
• Track, research, and assist with resolving enrollment-related denials, adjustments, and payer issues.
• Assist with enrollment-related appeals and payer escalations.
• Identify and escalate outstanding or pending enrollment and contract issues.
• Maintain knowledge of payer requirements and the unique regulatory and operational requirements of Federally Qualified Health Centers (FQHCs).
• Maintain patient confidentiality and comply with HIPAA requirements.
• Partner with internal departments to resolve enrollment and payer-related issues.
• Provide responsive, professional customer service to providers, coworkers, payers, and other external partners.
• Maintain a positive and professional image of Noble Community Clinics.

Skills

Payer enrollment

Credentialing

Interpersonal communication

Time management

Analytical thinking

Problem solving

Microsoft Office

CPR certification

Education

High school diploma

Tools

Microsoft Office

Job description

Noble Community Clinics is seeking a Credentialing Specialist to join our team in Manitowoc, WI. This role ensures providers and clinic sites stay enrolled with payers, manages contracting, revalidations, and related credentialing activities.

The position requires strong organizational, analytical, and communication skills, with experience in payer enrollment and familiarity with CAQH and Credential Stream. CPR certification within six months is required.