Credentialing Specialist

About the role

The Credentialing Specialist will manage provider credentialing, payer enrollment, and insurance contracting for a healthcare organization. This remote position ensures that providers stay properly enrolled, credentialed, and compliant with all applicable payers and regulations.

Key responsibilities

• Manage initial credentialing and re‑credentialing with commercial insurers, Medicare, Medicaid, and other payers.
• Complete and track payer enrollment applications from submission through approval.
• Maintain provider data in CAQH, NPPES, PECOS, state licensing boards, DEA registrations, and malpractice coverage registries.
• Monitor expiration dates, renew credentials, and coordinate onboarding for new providers.
• Serve as primary contact for credentialing communication with insurers and payer representatives.
• Update provider information in AthenaOne and other internal systems, and assist with audits.

Required profile

• High school diploma or GED equivalent.
• Minimum 3 years of dedicated medical provider credentialing experience.
• Proven ability to manage the full credentialing cycle independently.
• Strong organizational, communication, and detail‑orientation skills.

Required skills

• Hands‑on experience with CAQH, NPPES, PECOS.
• Familiarity with Medicare, Medicaid, and commercial insurance credentialing.
• Experience with state licensing, DEA registrations, and malpractice coverage.
• Knowledge of AthenaOne or similar EMR/practice‑management systems.
• Proficiency in Microsoft Office (Outlook, Word, Excel).