Medical Credentialing Specialist

Description

Billing Mate is seeking a detail-oriented Medical Credentialing Specialist to join our team and oversee the credentialing processes for healthcare providers. In this role, you will manage a team of three professionals and ensure the accurate and timely completion of credentialing, re-credentialing, and payer enrollment activities. Your expertise in provider data management, compliance with healthcare regulations, and various enrollment platforms will be essential to support our organization’s provider network integrity and reimbursement capabilities. You will serve as the key liaison between providers and payers, maintaining adherence to state and federal guidelines while enhancing operational efficiency. The ideal candidate has a minimum of two years’ experience in US Healthcare Provider Credentialing, demonstrating proficiency in CAQH, PECOS, NPPES, Medicare, and Medicaid enrollment processes. You possess strong organizational and communication skills, documenting all credentialing activities accurately while coordinating follow-ups with payers and providers to resolve any issues promptly. This role demands the ability to work independently, manage deadlines effectively, and lead a team dedicated to maintaining the highest standard of credentialing compliance and provider network readiness.

Responsibilities

• Lead and manage a team of three credentialing specialists, providing guidance, training, and performance oversight.
• Coordinate and oversee provider credentialing and re-credentialing processes, ensuring timely submission and completion according to payer requirements.
• Conduct thorough primary source verifications of provider credentials, including education, licensure, certifications, and work history.
• Manage payer enrollment activities, including Medicare, Medicaid, and commercial insurance credentialing and re-credentialing.
• Utilize credentialing platforms such as CAQH ProView and PECOS to maintain up-to-date provider data and support enrollment activities.
• Maintain and update accurate records of provider licensure, certifications, and enrollment status in compliance with HIPAA and credentialing regulations.
• Review and monitor state licensure and certification verifications to ensure all providers meet regulatory standards.
• Serve as a point of contact for providers and payers to resolve credentialing discrepancies, application issues, or other related concerns.
• Prepare and submit documentation required for payer applications and follow-up with payers to ensure process completion.
• Ensure compliance with all relevant healthcare laws, payer policies, and internal credentialing procedures.
• Monitor and track credentialing workflows and deadlines to meet contractual and regulatory requirements efficiently.
• Implement process improvements to streamline credentialing activities and enhance data accuracy.
• Collaborate with internal departments to support provider network development and maintenance.
• Report regularly on credentialing team performance, progress, and compliance status to management.
• Stay informed on changes in healthcare credentialing policies, regulations, and payer requirements.

Experience

2 Years

Apply By

Nov 15, 2026

Required Skills

• Provider credentialing and recredentialing
• Primary Source Verification
• Payer Enrollment And Provider Data Management
• CAQH ProView
• PECOS And Medicare Enrollment
• State Licensure And Certification Verification
• NPPES
• Medicare Enrollment
• Medicaid Enrollment
• commercial insurance credentialing

Nice to Have Skills

• HIPAA And Credentialing Compliance
• Documentation
• Communication
• Organizational Skills
• Team Leadership
• Deadline Management