Job Summary - IN

HOUSE POSITION - THIS IS NOT A REMOTE POSITION

. The Credentialing Specialist coordinates provider credentialing, recredentialing, and payer enrollment activities for a multi-location specialty medical practice. This role helps ensure that providers maintain active participation with commercial, Medicare, and Medicaid payers to support uninterrupted patient access and reimbursement. The Credentialing Specialist works closely with revenue cycle, billing, compliance, providers, and operational leadership to maintain accurate enrollment records, support regulatory compliance, and facilitate effective payer relationships.

Qualifications/Skills:

Education Bachelor's degree in healthcare administration, business administration, or related field preferred. Experience Three to five years of credentialing experience in a medical practice or healthcare organization preferred. Experience coordinating credentialing for a multi-provider practice. Experience working with Medicare, Medicaid, and commercial payers Specialty medical practice experience preferred. Certifications (Preferred) Certified Provider Credentialing Specialist ( CPCS ) Certified Professional Medical Services Management ( CPMSM ) Knowledge, Skills & Abilities Strong understanding of: Provider credentialing processes Payer enrollment requirements CAQH, PECOS, and payer portals Knowledge of healthcare compliance and regulatory requirements. Strong organizational skills with ability to manage multiple deadlines. Excellent communication skills for interacting with payers and providers. Ability to analyze credentialing issues impacting revenue cycle.

Responsibilities/Duties:

Provider Credentialing & Enrollment Coordinate initial credentialing and recredentialing for physicians and other eligible providers across multiple practice locations. Maintain provider participation with Medicare, Medicaid, and commercial insurance payers. Complete, coordinate, and submit credentialing applications, including: CAQH maintenance and attestations Payer enrollment applications Hospital and surgical center credentialing when required Track all credentialing expiration dates and proactively manage renewals to avoid lapses in participation. Payer Enrollment & Contract Management Coordinate provider enrollment with all contracted insurance plans. Coordinate credentialing timelines for new providers to support enrollment before patient services begin. Assist with payer contracting updates and maintain payer participation status across all practice locations. Maintain accurate group and individual provider enrollments. CAQH & Credentialing Systems Management Maintain provider profiles in CAQH, PECOS, and other credentialing platforms. Ensure timely updates and attestations in CAQH.

Maintain centralized credentialing records including:

Licenses Board certifications DEA registrations Malpractice insurance Continuing medical education Compliance & Regulatory Oversight Ensure all credentialing activities comply with: Medicare and Medicaid regulations State licensing requirements Payer participation requirements Maintain audit-ready credentialing files for all providers. Work with compliance leadership to support credentialing audits when required. Licenses, Permits & Regulatory Renewals Track and coordinate timely renewal of required city, county, and state business licenses, registrations, permits, and tax receipts for all locations. Maintain a centralized renewal calendar and complete required applications, supporting documentation, and fee requests before established deadlines. Coordinate required state biomedical waste permits for each applicable location and maintain current permits and supporting records. Communicate renewal status, inspection requirements, deficiencies, or potential compliance concerns promptly to operational and compliance leadership. Provider & Location Management Coordinate provider credentialing across multiple practice locations. Coordinate payer updates when providers change locations or add services. Ensure new locations are properly linked to enrolled providers. Revenue Cycle Collaboration Work closely with billing and authorization teams to: Ensure providers are properly enrolled prior to billing services. Resolve payer participation issues impacting reimbursement. Assist with resolving claim denials related to credentialing or enrollment issues. Reporting & Tracking Maintain credentialing dashboards and status reports for leadership.

Provide regular updates on:

Enrollment status Recredentialing timelines Payer participation issues Monitor credentialing turnaround times to support provider onboarding goals. Additional Requirements

Technology Proficiency:

Candidates must be able to effectively use Microsoft Office/Microsoft 365 applications, including but not limited to Microsoft Teams, Outlook, Word, Excel, and other Microsoft programs as required to perform the essential functions of the position. Additional software and technology platforms may be required based on business needs. Performance Metrics/Key Success Indicators Zero provider credentialing lapses. Timely completion of credentialing and recredentialing. Reduced claim denials related to credentialing issues. Efficient onboarding of new providers. Timely renewal of required organizational licenses and permits with no avoidable lapses.

Work Environment:

Office-based role supporting multiple practice locations. May require occasional interaction with providers and leadership at multiple practice sites.

Essential Physical Functions:

• Stand, walk and sit for extended periods of time
• Push, pull and reach; occasionally bend, stoop, and stretch.
• Hand-eye coordination and manual dexterity needed to operate a keyboard and other office equipment.
• Ability to hear and communicate effectively and to perform computer-based work requiring close visual focus.
• Ability to record, prepare, and communicate accurate reports.
• Occasionally lift up to 20 pounds

Pay:

From $25.00 per hour Expected hours: 40.0 per week

Benefits:

401(k) 401(k) matching AD&D insurance Dental insurance Health insurance Life insurance Paid time off Vision insurance

Experience:

Multi-Provider Practice:

3 years (Required) Working with Medicare, Medicaid and commercial payors: 3 years (Required)

Medical Credentialing :

3 years (Required)

Work Location:

In person