Credentialing Executive

The Credentialing Executive is responsible for managing the credentialing and re-credentialing processes for healthcare providers with insurance payers. The role ensures that providers are properly enrolled with insurance networks, maintains accurate credentialing records, and supports compliance with payer requirements to facilitate smooth medical billing and reimbursement operations.
Key Responsibilities:

• Manage end-to-end provider credentialing and re-credentialing with insurance companies and government payers.
• Prepare and submit provider enrollment applications for commercial and government payers.
• Maintain accurate records of provider credentials including licenses, certifications, malpractice insurance, and CAQH profiles.
• Regularly update and attest provider information in CAQH and other credentialing portals.
• Track application status and follow up with payers to ensure timely processing and approvals.
• Coordinate with internal departments such as billing, contracting, and compliance teams.
• Monitor credential expiration dates and ensure timely renewals.
• Maintain credentialing databases and documentation for audits and compliance.
• Resolve credentialing issues, rejections, and enrollment delays.
• Communicate with providers and payer representatives regarding credentialing requirements.

Required Qualifications:

• Bachelor’s degree in Healthcare Administration, Business Administration, or a related field (preferred).
• 1–2 years of experience in provider credentialing within a medical billing or healthcare organization.
• Knowledge of credentialing processes, payer enrollment, and insurance networks.
• Familiarity with CAQH, PECOS, NPPES, and payer portals.
• Strong organizational and documentation skills.
• Excellent communication and follow-up abilities.
• Ability to manage multiple credentialing tasks and deadlines.

Job Type: Full-time

Work Location: In person