Credentialing Specialist Salary: $50,000 - $60,000 DOE Location: Hybrid Opportunity Benefits: Comprehensive benefits package, growth opportunities, and the chance to make a meaningful impact in the community.
About the Opportunity A growing healthcare organization is seeking a detail-oriented Credentialing Specialist to support provider enrollment and credentialing activities. This role plays a critical part in ensuring healthcare providers are properly credentialed and enrolled with insurance payers so patients can continue receiving access to quality care. This is an excellent opportunity for someone who enjoys process management, compliance, relationship coordination, and working in a mission-driven environment that serves the community.
Key Responsibilities
- Manage provider credentialing and recredentialing processes for physicians and other healthcare providers.
- Complete and submit enrollment applications with commercial, government, and military insurance plans, including:
- BCBS/Anthem
- Tricare
- VA
- Medicare
- Cigna
- Monitor application status and proactively follow up with payers to ensure timely processing.
- Maintain accurate provider records and documentation within credentialing systems and databases.
- Track and monitor provider licenses, DEA registrations, board certifications, malpractice coverage, and other regulatory requirements to ensure ongoing compliance.
- Coordinate with internal stakeholders, healthcare providers, clinics, hospitals, and insurance representatives throughout the credentialing process.
- Research and resolve enrollment issues, denials, or missing documentation.
- Maintain strict attention to detail, recognizing that credentialing errors may not be identified until months after submission.
- Stay informed of payer requirements and regulatory changes impacting provider enrollment and credentialing.
If you are a highly organized credentialing professional who thrives in a fast-paced healthcare environment and takes pride in getting the details right, we'd love to hear from you.
Qualifications
- 2+ years of medical credentialing experience required.
- Experience credentialing healthcare providers with clinics, hospitals, and insurance carriers.
- Knowledge of provider enrollment processes for commercial and government payers.
- Experience working with Colorado and/or Kansas payer networks preferred.
- Strong computer skills and experience utilizing online credentialing and enrollment platforms.
- Exceptional organizational skills and attention to detail.
- Ability to manage multiple deadlines and maintain accurate records.
- Strong written and verbal communication skills.
- Self-motivated with the ability to work independently in a hybrid environment.
Preferred Experience
- Credentialing and enrollment experience with BCBS/Anthem, Tricare, VA, Medicare, and Cigna.
- Experience supporting multi-provider healthcare organizations.
- Familiarity with credentialing software and provider database management systems.