Credentialing Specialist

Posted Tuesday, September 8, 2026 at 5:00 AM Primary Responsibilities • Own end-to-end provider credentialing and enrollment processes from onboarding through approval and ongoing maintenance, delivering a high-touch, white-glove provider experience • Serve as the primary escalation point for complex credentialing issues, partnering with third-party vendor (Advantum) and insurance payors to drive timely resolution • Manage consistent, professional communication with assigned providers across a portfolio of 50+ practice locations, ensuring alignment and responsiveness • Oversee collection, validation, and ongoing maintenance of provider data and onboarding documentation to ensure accuracy, completeness, and compliance • Maintain end-to-end visibility and accountability for enrollment progress, followups, and project initiatives through effective ticketing system management and tracking • Ensure integrity, accuracy, and compliance of provider records and databases in accordance with internal standards and regulatory requirements • Guide providers through credentialing and re-credentialing processes, proactively addressing inquiries and ensuring timely resolution of outstanding items • Develop and maintain strong relationships with health plans and insurance payor representatives to support successful enrollment outcomes • Partner cross-functionally with internal stakeholders, including: o Revenue Cycle Management: Resolve billing issues related to credentialing status and enrollment gaps o Payor Relations: Align on timely execution of payor contracts to support accurate enrollment submissions • Proactively identify, analyze, and resolve enrollment gaps, delays, and risks impacting practice operations and revenue cycle performance • Ensure strict compliance with all applicable state and federal regulations, including Medicare and Medicaid requirements • Contribute to team initiatives focused on enrollment cleanup, process improvement, and operational efficiency • Perform additional credentialing, compliance, and operational support duties as assigned Minimum Qualifications / Requirements • Minimum of 2 years of direct provider enrollment and credentialing experience required • 2–3 years of administrative experience in a healthcare environment preferred • Working knowledge of Medicare, Medicaid, and commercial payor enrollment processes • Well versed within CAQH, NPPES, PECOS, and payor portals (e.g., Availity, One HealthCare ID, etc.) • High School diploma or GED required (Associate’s or Bachelor’s degree preferred) • Strong organizational skills with exceptional attention to detail • Ability to manage multiple priorities, deadlines, and competing demands in a fastpaced environment • Excellent communication, interpersonal, problem-solving, and critical thinking skills • Ability to work independently with minimal supervision while maintaining accountability • Comfortable working in a remote environment with video-based collaboration Key Competencies • Customer-focused with a high level of professionalism • Strong follow-through and accountability • Adaptability and resourcefulness in problem-solving • Cross-functional collaboration and relationship-building • Process-driven with a focus on accuracy and compliance