About the Role

We are seeking an experienced Credentialing Specialist with 2–3 years of hands-on experience in healthcare provider credentialing and enrollment. You will manage end-to-end credentialing processes, meet payer, regulatory and organizational requirements, and maintain accurate, timely records.

Key Responsibilities

• Perform end-to-end provider credentialing and re-credentialing.
• Prepare, review and submit applications to commercial, Medicare and Medicaid payers.
• Verify provider licenses, certifications, education, training, work history and malpractice history.
• Maintain accurate, up-to-date credentialing files and provider databases.
• Track credentialing status, expirations and renewals for timely re-credentialing.
• Follow up with payers, providers and internal teams to resolve delays or discrepancies.
• Ensure compliance with NCQA, CMS, state and payer-specific requirements.
• Audit credentialing files for accuracy and completeness.
• Prepare credentialing status reports for management or clients.
• Support provider enrollment, terminations and demographic updates.

Required Qualifications

• 2–3 years of experience in healthcare credentialing or provider enrollment.
• Strong knowledge of credentialing processes, payer requirements and compliance standards.
• Familiarity with Medicare, Medicaid and commercial payer portals.
• Experience with credentialing software and provider databases.
• Excellent organization, documentation, written communication and verbal communication skills.
• Ability to manage multiple providers and deadlines with high attention to detail.

Preferred Skills

• Knowledge of NCQA and CMS guidelines.
• Experience with audits and re-credentialing cycles.
• Proficiency in Microsoft Excel and Word.
• Ability to work independently and collaboratively.
• Proactive follow-up and problem-solving skills.

Key Competencies

• Compliance and quality focus
• Time management
• Provider and payer coordination
• Analytical and documentation skills
• Client communication

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