Credentialing Coordinator

Credentialing Specialist – Job Requirements
Position: Credentialing Specialist
Experience: 2+ years in U.S. Healthcare Credentialing / Provider Enrollment
Required Qualifications:
* Minimum 2 years of experience in U.S. healthcare credentialing and provider enrollment.
* Strong knowledge of CAQH, PECOS, NPPES/NPI, Medicare, Medicaid, and commercial payer enrollment.
* Experience with payer portals and enrollment applications.
* Knowledge of provider credentialing, recredentialing, and enrollment processes.
* Experience handling individual providers and group practices.
* Ability to complete and maintain CAQH profiles and ensure timely re-attestation.
* Familiarity with payer requirements for BCBS, Aetna, Cigna, UHC/Optum, Medicare, Medicaid, and Medicare Advantage plans.
* Ability to track applications from submission through approval, effective date, and participation status.
* Strong follow-up skills with insurance companies and credentialing departments.
* Ability to identify and resolve application errors, missing documents, and enrollment discrepancies.
* Maintain accurate credentialing trackers and documentation.
* Good knowledge of Excel/Google Sheets and ability to maintain enrollment reports.
* Strong written and verbal communication skills.
* Ability to work independently and manage multiple providers and payers simultaneously.
* Good attention to detail and ability to meet deadlines.
Preferred:
* Experience with Texas Medicaid/TMHP, Medicare PECOS, CAQH, Availity, Optum/UHC, and other payer portals.
* Experience with Tebra, Practice Fusion, or other healthcare practice-management systems.
* Experience with provider revalidation, recredentialing, demographic updates, EFT/ERA enrollment, and roster maintenance.
* Experience working with U.S. healthcare organizations or RCM companies.
Key Responsibilities:
1. Complete provider credentialing and payer enrollment applications.
2. Manage CAQH profiles and provider documents.
3. Submit and monitor Medicare, Medicaid, and commercial payer enrollments.
4. Follow up with payers on pending applications.
5. Maintain accurate credentialing and enrollment trackers.
6. Monitor provider license, DEA, malpractice, board certification, and other expirations.
7. Handle recredentialing and revalidation activities.
8. Coordinate with providers and internal RCM teams to obtain required documents.
9. Verify provider participation and effective dates.
10. Prepare regular enrollment status reports for management.

Work arrangement
Yes