The Credentialing Specialist is responsible for overseeing the full provider credentialing and re-credentialing process across multiple insurance networks, payers, and credentialing systems. This role requires a highly organized and detail-focused professional with strong follow-up and coordination skills to ensure continuous regulatory compliance, uninterrupted provider participation, and efficient billing and authorization operations. The position plays an essential role in maintaining operational effectiveness and supporting accurate, timely reimbursements.
Key ResponsibilitiesCredentialing & Compliance
Maintain, organize, and routinely update provider credentialing records for both government and commercial insurance payers.
Manage CAQH profiles and ensure compliance with CMS regulations and payer-specific credentialing requirements.
Process initial credentialing, re-credentialing, and payer enrollment applications for Medicare, Medicaid, and private insurance netwo...