Credentialing

The Medical Credentialing Specialist is responsible for managing the enrollment, credentialing, and recredentialing of healthcare providers with Medicare, Medicaid, commercial insurance companies, and hospitals. This role ensures providers remain compliant with payer and regulatory requirements while maintaining accurate provider records and tracking credentialing deadlines. The specialist works closely with insurance carriers, practice administrators, and providers to ensure timely approvals and uninterrupted network participation.

Key Responsibilities:

• Process provider enrollments, credentialing, and recredentialing applications.
• Maintain CAQH profiles and provider credentialing records.
• Track license, DEA, malpractice insurance, and certification expirations.
• Communicate with insurance companies regarding application status.
• Resolve credentialing issues and follow up on pending applications.
• Maintain credentialing spreadsheets and documentation.
• Ensure compliance with payer and regulatory requirements.
• Assist with adding providers to existing payer contracts.