.
.

Requirements

Job Requirements:

Minimum 2 years of experience in provider credentialing and enrollment, specifically with CAQH, Medicaid, Medicare (PECOS portal), and NPI creation.

Strong knowledge of provider enrollment processes and payer credentialing requirements.

Ability to manage multiple applications across various states and payors efficiently.

Excellent communication and organizational skills.

Detail-oriented with strong follow-up and problem-solving abilities.

Proficient in credentialing portals and software platforms.

Description

We're Hiring Credentialing Specialist

Job Title: Credentialing Specialist
Experience Required: 2+ Years

Job Deion:

We are seeking a detail-oriented and experienced Credentialing Specialist with a strong background in provider enrollment and credentialing processes. The ideal candidate will have hands-on experience with CAQH, Medicaid, Medicare via the PECOS portal, and NPI creation. This role plays a vital part in ensuring that healthcare providers are accurately enrolled with payors and meet all regulatory requirements.

Key Responsibilities:

• Prepare, submit, and manage credentialing and contracting applications to insurance payors across multiple U.S. states.

• Complete provider applications and ensure timely submission.

• Create and maintain provider profiles in CAQH, PECOS, NPPES (NPI), Medicare, and Medicaid systems.

• Track application progress and maintain regular communication with payors, clinicians, and verification bodies.

• Respond promptly and professionally to queries via email and other communication channels.

• Maintain up-to-date knowledge of payer rules, credentialing requirements, and regulatory changes impacting provider enrollment.

• Notify providers of new regulations, upcoming expirations, reapplication needs, and credentialing deficiencies.

• Contribute to process improvements and help drive operational efficiency within the credentialing team.

• Perform special projects and other related duties as assigned.

Requirements:

• Minimum 2 years of credentialing experience with CAQH, Medicaid, Medicare (via PECOS), and NPI registration.

• Strong understanding of provider enrollment processes and payer credentialing requirements.

• Experience handling multi-state credentialing and payor communications.

• Proficient with credentialing platforms and portals (CAQH, PECOS, NPPES, etc.).

• Excellent communication skills and the ability to manage multiple tasks and deadlines.

• Detail-oriented with strong organizational and follow-up skills.

• Ability to work independently and as part of a team.