Credentialing Specialist

CH Revenue Management Solutions (CHRMS) is seeking a Credentialing Specialist to join its growing team. CHRMS represents out-of-network surgeons throughout the United States in the medical claim reimbursement cycle, from medical billing through appeals, including claims through the arbitration process under Federal and State laws. Our team is comprised of more than 60 professional medical billers, coders, insurance professionals, and industry experts. This opportunity is for the right individual to be part of an entrepreneurial work environment with a good work/life balance. The Credentialing Specialist is responsible for supporting provider credentialing, enrollment, disenrollment, and onboarding activities for an out-of-network surgical specialty billing company. This role maintains accurate provider directory and onboarding spreadsheets to track where and when providers are credentialed, monitor enrollment status, and document follow-up actions taken throughout the credentialing lifecycle. The ideal candidate is experienced in provider enrollment with federal and state entities, as well as disenrollment from commercial payers and Medicare/Medicaid managed care plans, and has a strong working knowledge of credentialing processes.

THIS IS A FULL-TIME IN-OFFICE POSITION.

Must have out-of-network credentialing experience. Key Responsibilities Credentialing & Verification

• Coordinate provider credentialing and recredentialing activities for out-of-network surgeons and surgical specialists.
• Maintain provider directory and onboarding spreadsheets to track where and when providers are credentialed, current application status, and all follow-up actions taken.
• Review credentialing and enrollment applications for completeness and accuracy.
• Maintain provider credential files in accordance with federal, state, and payer requirements.
• Monitor expiration dates and support timely renewals of licenses, certifications, malpractice coverage, and other required provider information.
• Demonstrate knowledge of primary source verification requirements and processes, although direct primary source verification is not a core responsibility of this role. Provider Enrollment & Facility Credentialing
• Facilitate provider enrollment with federal and state entities, including Medicare, Medicaid, and other applicable government programs.
• Coordinate provider disenrollment from commercial payers and Medicare/Medicaid managed care plans as needed.
• Support onboarding activities by organizing required documentation, tracking submissions, and following up with payers, agencies, and internal stakeholders.
• Track application and disenrollment status and resolve delays through timely and well-documented follow-up. Out-of-Network Operations
• Support onboarding of providers serving an out-of-network surgical specialty billing organization.
• Ensure provider documentation required for enrollment, credentialing support, and claims-related operations is maintained and readily accessible.
• Collaborate with billing, revenue cycle, and internal operational teams to support provider setup and reimbursement readiness.
• Maintain accurate provider demographic, practice, and credentialing status information for operational and compliance purposes.

Compliance & Quality Assurance Ensure compliance with CMS, NCQA, Joint Commission, state licensing boards, and payer-specific credentialing requirements. Prepare documentation for audits, accreditation reviews, and compliance inspections. Maintain confidentiality and security of provider information in accordance with HIPAA regulations. Develop and implement credentialing process improvements to enhance efficiency and reduce onboarding timelines. Reporting & Communication Generate credentialing status reports and maintain accurate tracking systems. Communicate regularly with surgeons, practice administrators, hospital credentialing departments, and internal stakeholders. Provide timely updates regarding credentialing status, deficiencies, and renewal requirements. Qualifications Knowledge & Skills Strong knowledge of provider credentialing, enrollment, and disenrollment requirements. Working knowledge of primary source verification processes and credentialing documentation standards. Familiarity with Medicare, Medicaid, commercial payer, and managed care enrollment workflows. Advanced proficiency with Microsoft Excel and other tracking tools used to maintain provider directory and onboarding spreadsheets. Proficiency with credentialing software, provider databases, and Microsoft Office Suite. Exceptional organizational skills and attention to detail. Strong problem-solving, communication, and follow-up skills. Ability to manage multiple provider records, deadlines, and status updates simultaneously while maintaining accuracy. Education and Experience Associate's degree or bachelor's degree in healthcare administration, Business Administration, or a related field preferred. Equivalent credentialing experience may be considered. Minimum of 3 years of healthcare credentialing and/or provider enrollment experience. Experience supporting orthopedic, spine, neurosurgery, pain management, general surgery, plastic surgery, or other surgical specialties and podiatry. Knowledge of revenue cycle management and out-of-network claims processes. Experience enrolling providers with federal and state entities required. Experience disenrolling providers from commercial payers and Medicare/Medicaid managed care plans strongly preferred. Experience supporting surgeons or surgical specialties in an out-of-network environment preferred. Salary and Benefits Salary range $26.50-$31.25 We offer our team paid time off, medical, dental, vision, 401(k) with match, LTD, STD, FSA, Pet Wellness Plans, and supplemental insurance plans.

EOE/DFWP

Pay:

$26.50 - $31.25 per hour

Benefits:

401(k) matching Dental insurance Flexible spending account Free parking Health insurance Life insurance Vision insurance

Work Location:

In person