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Credentialing Specialist

  • erform end-to-end credentialing and re-credentialing for healthcare providers with US insurance payers
  • Handle payer enrollments (Medicare, Medicaid, and commercial plans) to ensure billing readiness
  • Maintain and regularly update CAQH profiles, ensuring accuracy for claim processing
  • Verify provider eligibility before onboarding to avoid claim rejections/denials
  • Coordinate closely with medical billing teams to resolve credentialing-related claim issues
  • Monitor and follow up on pending applications to prevent revenue delays
  • Ensure all provider data (NPI, taxonomy, licenses, malpractice insurance) is accurate and up to date
  • Work on ERA/EFT enrollments to streamline payment processes
  • Support denial management by identifying credentialing gaps impacting reimbursements
  • Maintain compliance with payer-specific guidelines and regulatory requirements
  • Prepare credentialing status reports, turnaround time tracking, and aging reports

Job Type: Full-time

Work Location: In person

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