Credentialing Specialist

About This Role

This part-time Credentialing Specialist role supports clinicians and expands access to quality behavioral health services. The specialist manages provider credentialing, enrollment, and recredentialing with various insurance plans and third-party payers, ensuring uninterrupted provider participation, compliance, and reimbursement. The position works 20 hours a week and suits a detail-oriented, organized individual committed to the mission of serving individuals and families.

Responsibilities

• Coordinate provider enrollment, credentialing, recredentialing, and disenrollment activities for Medicare, Medicaid, commercial insurance payers, and other third-party reimbursement programs
• Prepare, submit, and track credentialing, recredentialing, payer enrollment, demographic update, and provider maintenance applications through approval and implementation
• Maintain accurate and complete provider records, credentialing files, and enrollment documentation within credentialing databases, payer portals, and other designated systems
• Monitor and track the status of credentialing applications, payer enrollments, and provider participation to ensure timely completion and uninterrupted network participation
• Monitor expiration and renewal dates for licenses, certifications, malpractice insurance, DEA registrations, and other required credentials, obtaining updated documentation as necessary
• Research payer requirements, regulatory changes, and enrollment guidelines, communicating updates that may impact provider participation, reimbursement, or compliance
• Collaborate with providers, payer representatives, billing staff, and internal stakeholders to resolve credentialing discrepancies, enrollment issues, and participation delays
• Verify payer participation status, effective dates, and provider enrollment information to support accurate billing and reimbursement processes
• Coordinate the addition of new providers, service locations, and provider changes with applicable payer networks
• Prepare credentialing reports, enrollment status updates, and related data for leadership and operational stakeholders
• Support internal audits, external reviews, accreditation activities, and compliance initiatives by maintaining complete, accurate, and audit-ready documentation
• Perform other related duties as assigned

Requirements

• High school diploma or equivalent required
• Associate's degree preferred
• Minimum of 4 years of healthcare credentialing, provider enrollment, medical billing, or related experience preferred
• Experience managing provider enrollment, credentialing, and recredentialing processes
• Knowledge of Medicare, Medicaid, commercial insurance, and other third-party payer credentialing requirements