Sr Credentialing Rep

We are looking for an experienced Sr Credentialing Representative to support provider enrollment and credentialing operations. The Sr Credentialing Representative role focuses on ensuring practitioner files are accurate, current, and compliant while coordinating submissions to commercial and government payers. The ideal Sr Credentialing Representative brings strong attention to detail, knowledge of credentialing standards, and the ability to manage high-volume documentation with precision.

Responsibilities:

• Prepare and submit initial credentialing and recredentialing applications for providers with contracted insurance payers, ensuring all records are complete and timely.
• Maintain provider licenses, certifications, and related documents by monitoring expiration dates and coordinating renewal activities.
• Update and manage CAQH profiles and other enrollment records to keep practitioner information accurate across credentialing platforms.
• Perform roster maintenance, delegation-related data entry, and payer record updates within systems such as Symplr Payer and other credentialing tools.
• Conduct primary source verification by reviewing licensing boards, certification databases, and other approved sources to confirm provider qualifications.
• Process enrollments with commercial insurers and government programs, including plans governed by applicable state and federal requirements.
• Review credentialing files for quality, completeness, and alignment with NCQA, AAAHC, Joint Commission, and internal compliance standards.
• Support hospital privilege documentation and verify related information to help maintain accurate provider participation records.