Find & Apply For Network Engineer / Architect Jobs in Parkersburg, West Virginia

Job Summary We are seeking an experienced Credentialing & Contracting Specialist to manage provider credentialing, payer enrollment, recredentialing, and insurance contracting across multiple states, with a primary focus on West Virginia and Ohio. The ideal candidate will have hands-on experience with Medicare, Medicaid, Managed Medicaid, and commercial insurance carriers and be comfortable independently managing credentialing and contracting processes from application through effective date. Key Responsibilities Complete provider and facility credentialing, enrollment, and recredentialing. Manage Medicare, Medicaid, Managed Medicaid, and commercial payer applications. Maintain CAQH, PECOS, NPPES, Availity , and payer portals. Manage provider additions, terminations, demographic changes, and reassignments. Track licenses, malpractice insurance, certifications, and credentialing expirations. Submit and track payer contracting and network participation requests. Maintain payer contracts, fee schedules, amendments, and provider rosters. Follow up with insurance carriers and resolve enrollment or contracting issues. Work with Billing, Revenue Cycle, Compliance, and Operations to prevent credentialing-related claim delays. Maintain accurate, organized, and audit-ready credentialing records. Qualifications 3-5 years of healthcare credentialing, payer enrollment, and/or contracting experience required. Strong experience with Medicare, Medicaid, and commercial insurance . Multi-state credentialing experience; West Virginia and/or Ohio experience strongly preferred . Experience with CAQH, PECOS, NPPES, and Availity . Knowledge of NPIs, Tax IDs, taxonomy codes, Medicare enrollment, Medicaid enrollment, and payer credentialing requirements. Behavioral health or substance use disorder treatment experience preferred. Strong organizational, communication, follow-up, and problem-solving skills. Ability to independently manage multiple providers, payers, applications, and deadlines.

Preferred Payer Experience:

UnitedHealthcare/Optum, Aetna, Cigna/Evernorth, Highmark/BCBS, Molina, CareSource, Buckeye Health Plan, and other regional or national payers. Join our team as a Credentialing & Contracting Specialist to play a key role in maintaining the integrity of our provider network while supporting our mission to deliver compliant, high-quality healthcare services!

Benefits:

401(k) Dental insurance Health insurance Paid time off Vision insurance

Work Location:

Hybrid remote in Parkersburg, WV 26101