Credentialing Specialist, Contracts

Description

Responsibilities

• Manage end-to-end provider and facility credentialing and recredentialing processes for assigned client accounts.
• Prepare, submit, track, and maintain payer enrollment and participation applications for Medicare, Medicaid, and all major commercial payers.
• Verify provider and facility credentials, including state licenses, NPI, DEA, malpractice coverage, CAQH profiles, board certifications, accreditations,and other required documentation.
• Maintain accurate, organized, and audit-ready credentialing records within internal databases, payer portals, and client systems.
• Monitor application status and perform timely follow-ups with payers to ensure prompt approvals and minimize enrollment delays.
• Communicate effectively with providers, facilities, payers, and internal stakeholders to resolve credentialing and enrollment issues.
• Proactively monitor upcoming expirations and initiate renewals to ensure uninterrupted provider and facility participation in payer networks.
• Collaborate with Contracting, Revenue Cycle Management (RCM), and Billing teams to align credentialing activities with payer contracts and claim submission readiness.
• Prepare and share regular credentialing and enrollment status reports with clients, providing accurate updates on pending, approved, and outstanding items.
• Stay current with CMS regulations, Medicare and Medicaid guidelines, NCQA standards, and commercial payer credentialing requirements to ensure compliance.

Requirements

Qualifications

• Associate's or Bachelor's degree preferred, preferably in Healthcare Administration, Business Administration, or a related field.
• Minimum 2 years of provider credentialing and payer enrollment experience, preferably within an RCM vendor, healthcare organization, or multi-client environment.
• Strong knowledge of Medicare, Medicaid, and commercial payer credentialing and enrollment processes.
• Hands-on experience with PECOS, CAQH, NPPES, payer portals, and credentialing/enrollment software.
• Facility credentialing experience is highly preferred and will be considered a Significant advantage.
• Strong understanding of provider and facility enrollment requirements for government and commercial health plans.
• Excellent organizational, documentation, and analytical skills with strong attention to detail.
• Ability to manage multiple client accounts, priorities, and deadlines simultaneously.
• Strong typing skills with the ability to maintain accurate and timely documentation.
• Excellent verbal and written communication skills, including the ability to professionally communicate with clients, providers, facilities, and payer representatives.
• Ability to independently prepare and present client status updates and credentialing progress reports.
• Proficiency in Microsoft Office Suite, including Excel, Word, Outlook, and credentialing management systems.

Preferred Skills

• Expertise in both Provider and Facility Credentialing.
• Strong working knowledge of Medicare, Medicaid, and all major commercial payers.
• Experience managing credentialing activities across multiple clients and payer networks.
• Client-facing experience with status reporting and stakeholder communication.

Ability to identify, troubleshoot, and resolve credentialing and enrollment issues