Credentialing Specialist

A company is looking for a Credentialing / Enrollment Specialist responsible for managing provider credentialing and payer enrollment.

Key Responsibilities

Process and manage initial and recredentialing applications in compliance with NCQA standards and payer requirements

Maintain accurate provider credentialing files and monitor expirables such as licenses and certifications

Facilitate provider enrollment with commercial and government payers across multiple states

Required Qualifications

High school degree or equivalent education and training required

Minimum of three (3) years of credentialing and provider enrollment experience required

Familiarity with CAQH, NPDB, AVAILITY, PECOS, and other payer portals

Ability to work independently in a fast-paced environment

Ability to maintain confidentiality of privileged information at all times