About This Role
Managing provider credentialing, recredentialing, and payer enrollment is the core of this specialist role. The post is for a detail-oriented and experienced candidate with a background in US healthcare insurance payers and provider enrollment processes.
Responsibilities
- Manage initial credentialing and recredentialing for physicians, therapists, and other healthcare providers
- Complete and submit provider applications to Medicare, Medicaid, and commercial insurance payers
- Maintain provider information in CAQH and other payer portals
- Follow up with insurance payers regarding application status, missing documents, and approvals
- Track credentialing and recredentialing timelines to ensure timely submissions
- Manage provider enrollment, additions, terminations, and demographic updates
- Maintain accurate credentialing files, provider records, licenses, certifications, and other required documents
- Coordinate with providers and internal teams to obtain required documentation
- Work with payer portals and systems such as CAQH, Availity, Medicare, Medicaid, and commercial payer websites
- Prepare and maintain credentialing status reports and trackers
- Identify and resolve credentialing-related issues, delays, and denials
- Ensure compliance with payer, state, federal, and organizational requirements
Requirements
- Minimum 2–5 years of experience in US healthcare provider credentialing and payer enrollment
- Strong knowledge of Medicare, Medicaid, and commercial payer credentialing processes
- Experience with CAQH and payer portals
- Understanding of provider enrollment, revalidation, recredentialing, and contracting processes
- Excellent communication and follow-up skills
- Strong attention to detail and organizational skills
- Ability to manage multiple providers and applications simultaneously
- Proficiency in Microsoft Excel and other reporting tools
Nice to have:
- Experience in behavioral health or multi-specialty credentialing
- Experience working with multiple state Medicaid programs
- Knowledge of NPI, taxonomy, PECOS, and provider enrollment requirements
- Experience working with RCM or medical billing organizations
Important Details
- Employment type: Full-Time
