Provider Credentialing Specialist

Accountabilities: The Provider Credentialing Specialist will manage end-to-end credentialing and enrollment activities for healthcare providers while maintaining accurate records, ensuring compliance, and proactively resolving payer-related issues. This role requires strong ownership of workflows, consistent communication, and the ability to manage multiple credentialing processes simultaneously.

Manage provider credentialing and re-credentialing workflows from application preparation through final approval.

Collect, verify, and organize required documentation from providers to support enrollment processes.

Prepare and submit credentialing applications for commercial and government payers.

Complete re-credentialing submissions ahead of provider expiration deadlines.

Manage NPI enrollment, PECOS enrollment, Medicare, Medicaid, and payer-specific requirements.

Track credentialing applications, submission timelines, payer responses, approvals, and outstanding requirements.

Maintain accurate CAQH profiles, complete attestations, and ensure provider information remains current.

Conduct monthly sanctions checks and maintain audit-ready credentialing documentation.

Monitor payer application statuses through proactive phone and email follow-ups.

Act as a reliable point of contact for providers, payers, and internal stakeholders regarding credentialing questions.

Escalate delays, missing documentation, or payer issues that may impact timelines.

Support provider offboarding processes, including payer notifications and record updates.

Provide occasional billing or administrative support, including claims follow-up and payer communication, when required.

Requirements:

The ideal candidate has hands-on experience managing healthcare provider credentialing processes and understands the importance of accuracy, compliance, and proactive communication. This role requires someone who is highly organized, detail-oriented, and comfortable independently managing multiple active workflows.

2+ years of direct provider credentialing experience required; this is not an entry-level position.

Proven experience managing full credentialing workflows, including applications, payer follow-up, documentation, and re-credentialing.

Strong knowledge of CAQH, NPI enrollment, payer credentialing requirements, and enrollment processes.

Experience working with Medicare, Medicaid, and commercial insurance payers.

Comfortable making proactive follow-up calls to insurance payers and coordinating documentation with providers.

Exceptional attention to detail with strong deadline management and follow-through.

Ability to manage multiple credentialing projects and maintain accurate tracking systems.

Strong written and verbal English communication skills.

Proficiency with Microsoft Office Suite (Word, Excel, Outlook) or Google Workspace.

Reliable home office setup with stable internet connectivity.

Experience credentialing healthcare professionals such as Physical Therapists, Occupational Therapists, or Speech-Language Pathologists is preferred.

Familiarity with PECOS, CMS enrollment portals, EMR systems, or practice management platforms is a plus.

Experience supporting multi-state credentialing, high-volume clinics, or contract provider environments is preferred.

Basic knowledge of billing or accounts receivable processes is an advantage.

Strong ownership mindset with the ability to track applications through completion.

Persistence and confidence in resolving payer delays and obtaining timely updates.

Professional communication skills when working with providers, payers, and leadership teams.

Benefits:

Competitive salary based on experience.

Full-time remote work opportunity supporting U.S.-based healthcare clients.

Stable employment with opportunities for long-term career growth.

Professional development opportunities to expand healthcare operations expertise.

Collaborative and supportive team environment.

Opportunity to make a meaningful impact by helping healthcare organizations operate more efficiently.

How Jobgether works: We use an AI-powered matching process to ensure your application is reviewed quickly, objectively, and fairly against the role's core requirements. Our system identifies the top-fitting candidates, and this shortlist is then shared directly with the hiring company. The final decision and next steps (interviews, assessments) are managed by their internal team. We appreciate your interest and wish you the best!  Why Apply Through Jobgether? 

Data Privacy Notice: By submitting your application, you acknowledge that Jobgether will process your personal data to evaluate your candidacy and share relevant information with the hiring employer. This processing is based on legitimate interest and pre-contractual measures under applicable data protection laws (including GDPR). You may exercise your rights (access, rectification, erasure, objection) at any time.

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