Credentialing Specialist

We are seeking a detail-oriented and experienced Credentialing Specialist to join our growing medical billing team. The Credentialing Specialist will be responsible for managing all aspects of provider credentialing and re-credentialing processes with insurance payers, hospitals, and medical groups. This role requires strong organizational skills, a deep understanding of healthcare credentialing requirements, and the ability to work independently in a remote setting.

Key Responsibilities:

• Coordinate and complete initial and re-credentialing applications for healthcare providers.
• Maintain current and accurate provider data in all systems and credentialing databases.
• Monitor credentialing timelines to avoid lapses in privileges or payer enrollment.
• Communicate with insurance companies, medical groups, and hospital credentialing departments to follow up on application statuses.
• Assist with provider enrollments, group contracts, and insurance updates.
• Provide regular updates and reports to leadership on credentialing status.
• Resolve credentialing issues efficiently and professionally.

Requirements

• 2+ years of experience in healthcare credentialing and payer enrollment (medical billing experience a plus).
• Experience credentialing providers in California, Utah and Texas.
• Knowledge of podiatry, primary care, or multi-specialty practices.
• Strong knowledge of commercial insurance, Medicare, and Medi-Cal enrollment processes.
• Familiarity with CAQH, PECOS, NPPES, and provider portals.
• Excellent attention to detail and organizational skills.
• Ability to manage multiple credentialing files and deadlines simultaneously.
• Strong written and verbal communication skills.
• Proficient in Microsoft Office Suite (Excel, Word, Outlook); experience with credentialing software preferred.
• Self-motivated and capable of working remotely with minimal supervision.
• High school diploma or GED required; associate or bachelor’s degree preferred.