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Provider Credentialing & Accounts Receivable Specialist
Provider Credentialing & Accounts Receivable SpecialistCoreLife Healthcare • Baltimore, MD, United States
Provider Credentialing & Accounts Receivable Specialist

Provider Credentialing & Accounts Receivable Specialist

CoreLife Healthcare • Baltimore, MD, United States
2 days ago
Job type
  • Full-time
Job description

📢 Now Hiring : Provider Credentialing & Accounts Receivable Specialist

Location : Linthicum, MD

Reports To : Vice President, RCM Operations

Employment Type : Full-Time

CoreLife is seeking a detail-oriented and highly motivated Provider Credentialing & Accounts Receivable Specialist to join our team. This dual-function role is critical in ensuring accurate provider enrollment, maintaining credentialing compliance, and supporting revenue cycle operations. If you have a strong background in medical credentialing, payer enrollment, and A / R management-and enjoy working in a fast-paced, mission-driven environment-we'd love to hear from you!

🔍 Key Responsibilities

Credentialing & Enrollment :

  • Prepare and submit provider enrollment applications and supporting documentation across multiple payers.
  • Maintain accurate and compliant records for licenses, certifications, and insurance contracts.
  • Track and process new enrollments, revalidations, ERN / ERA submissions, and roster updates.
  • Coordinate with HR, providers, and billing teams to streamline onboarding and credentialing processes.
  • Manage CAQH profiles and update PECOS and NPPES as needed.
  • Maintain HIPAA-compliant credentialing files and communication with payer credentialing teams.

Accounts Receivable Management :

  • Review and manage aging A / R >

    • 30 days, ensuring timely follow-up and maximum reimbursement.

  • Address denied claims, rework errors, file appeals, and communicate with payers as needed.
  • Monitor payer reimbursements against contracted rates.
  • Provide coverage and support across the team during absences or high-volume periods.
  • Work within EPIC and NextGen systems, and utilize EMR tools for charge entry and collections tracking.

    • 📚 Qualifications

    Required :

  • High school diploma or equivalent.
  • Minimum 3 years of experience in provider credentialing and / or medical billing.
  • Experience with PECOS and ePREP.
  • Knowledge of payer requirements and CPT / ICD-10 coding.

    • Preferred :

  • Associate or Bachelor's degree in healthcare, business, or related field.
  • 5+ years of experience in credentialing and A / R management.
  • Experience with EPIC and NextGen.
  • Familiarity with NCQA standards and processes.

    • 🧠 Skills & Abilities

  • Exceptional attention to detail and organizational skills.
  • Ability to multitask, prioritize, and work independently.
  • Strong problem-solving and critical thinking capabilities.
  • Excellent communication and interpersonal skills.
  • Proficiency with Microsoft Excel and payer web portals.
  • Commitment to confidentiality and HIPAA compliance.

    • 💙 Why CoreLife?

    At CoreLife, we are committed to delivering exceptional patient outcomes and creating a supportive, respectful environment for our team. You'll be part of an innovative, growing company dedicated to transforming healthcare through integrated, whole-person care.

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    Credentialing Specialist • Baltimore, MD, United States