Credentialing & Compliance Specialist 4.6 4.6 out of 5 stars 5050 South 2nd Street, Milwaukee, WI 53207 $70,000
- $80,000 a year
- Full-time Anodyne, LLC 5 reviews $70,000
- $80,000 a year
- Full-time Position Summary The Credentialing & Compliance Specialist oversees provider, facility, and DMEPOS credentialing, payor enrollment, licensure verification, accreditation records, and compliance tracking to maintain billing eligibility and ensure readiness for audits and regulatory requirements.
The position serves as the central point of coordination for compliance oversight, credentialing verification, regulatory monitoring, and internal policy adherence.
Job Location:
This position is an on-site role working off our 5050 S 2nd St Milwaukee, WI 53207 facilities.
Pay Range:
$70,000
- 80,000 Credentialing & Payor Enrollment Management Manage provider, facility, and DMEPOS credentialing and recredentialing activities with Medicare, Medicaid, commercial insurance payors, and accreditation organizations.
Coordinate enrollment applications, renewals, updates, and terminations through PECOS, NPPES, CAQH, and commercial payor portals. Maintain accurate credentialing records, licensure documentation, certifications, contracts, and provider files. Track expiration dates for licenses, certifications, insurance, and credentialing requirements to ensure timely renewals and uninterrupted billing eligibility. Conduct credentialing outreach to providers, partners, and stakeholders to obtain and maintain required documentation. Serve as a primary liaison with insurance payors regarding credentialing status, enrollment requirements, application follow-up, and issue resolution. Support onboarding of providers, practitioners, and branch locations by ensuring all credentialing and enrollment requirements are completed. Assist with insurance and Medicare compliance onboarding to ensure documentation and regulatory requirements are met. Compliance Monitoring & Regulatory Support Support the organization's regulatory compliance initiatives and maintain audit-ready documentation in accordance with federal, state, Medicare, and accreditation standards. Prepare and maintain ABC accreditation applications, supporting documentation binders, and ongoing compliance records. Maintain and oversee the National Dispensing Log to ensure records meet applicable regulatory and accreditation standards. Monitor regulatory updates and compliance changes and communicate relevant updates to internal stakeholders. Conduct internal compliance audits and documentation reviews to ensure adherence to company policies and regulatory requirements. Assist with complaint investigation documentation, corrective action tracking, and compliance follow-up activities. Prepare and distribute credentialing, compliance, and audit reports for leadership review. Support external audits, accreditation reviews, and regulatory inquiries as needed. Documentation, Training & Program Administration Develop and maintain compliance documentation, credentialing forms, training materials, and internal resources, including SharePoint or shared document repositories. Coordinate and administer annual employee compliance training programs, ensuring completion tracking and documentation retention. Assist internal teams and external customers with DME application processes and credentialing or compliance requirements. Provide audit support, compliance guidance, and retraining assistance as necessary to maintain regulatory adherence. Maintain organized, confidential, and audit-ready credentialing and compliance records. Operational Support & Stakeholder Assistance Provide customer or patient support related to credentialing documentation, compliance requirements, and regulatory troubleshooting. Assist with insurance plan troubleshooting related to credentialing, enrollment, documentation, or compliance matters. Contribute to educational communications, newsletters, and compliance-related content when needed. Support special credentialing, compliance, or regulatory projects as assigned. Qualifications Bachelor's degree in Healthcare Administration, Business Administration, Compliance, Legal Studies, or a related field preferred. Minimum of 3 years of experience in healthcare credentialing, provider enrollment, medical insurance enrollment, regulatory compliance, or related healthcare administration functions required. Experience working with Medicare, Medicaid, commercial insurance credentialing, or DMEPOS enrollment strongly preferred. Experience supporting healthcare accreditation programs such as ABC, ACHC, or similar accreditation organizations preferred. Familiarity with PECOS, CAQH, NPPES, and healthcare credentialing systems preferred. Knowledge of healthcare regulatory compliance standards and documentation requirements within DME, orthotics/prosthetics, medical devices, or healthcare services preferred. Certifications (Preferred) Certified Provider Credentialing Specialist (CPCS) Certified Professional Medical Services Management (CPMSM) Certified in Healthcare Compliance (CHC) Certified Compliance & Ethics Professional (CCEP) Key Competencies Strong understanding of healthcare credentialing, provider enrollment, and medical payor processes. Knowledge of Medicare DMEPOS enrollment requirements and healthcare regulatory compliance standards. Experience managing credentialing databases, verification processes, and audit-ready documentation. Strong organizational skills with the ability to manage multiple deadlines and priorities. Excellent attention to detail and documentation control. Ability to support audits, accreditation reviews, and compliance investigations. Effective communication and cross-functional collaboration skills. High level of discretion and confidentiality.
Working Conditions:
May require sitting for long periods and light lifting (up to 25 lbs). Corporate office environment located in Milwaukee, Wisconsin. Standard business hours with occasional extended hours to meet regulatory deadlines or audit requirements. Travel between branch locations in Oregon, and Florida is required.
Pay:
$70,000.00
00 per year
Benefits:
401(k) 401(k) matching AD&D insurance Dental insurance Employee discount Free parking Health insurance Life insurance Paid time off Vision insurance
Work Location:
In person
