Credentialing Specialist

Primary Responsibilities
• Own end-to-end provider credentialing and enrollment processes from onboarding through approval and ongoing maintenance, delivering a high-touch, white-glove provider experience
• Serve as the primary escalation point for complex credentialing issues, partnering with third-party vendor (Advantum) and insurance payors to drive timely resolution
• Manage consistent, professional communication with assigned providers across a portfolio of 50+ practice locations, ensuring alignment and responsiveness
• Oversee collection, validation, and ongoing maintenance of provider data and onboarding documentation to ensure accuracy, completeness, and compliance
• Maintain end-to-end visibility and accountability for enrollment progress, followups,
and project initiatives through effective ticketing system management and
tracking
• Ensure integrity, accuracy, and compliance of provider records and databases in
accordance with internal standards and regulatory requirements
• Guide providers through credentialing and re-credentialing processes, proactively
addressing inquiries and ensuring timely resolution of outstanding items
• Develop and maintain strong relationships with health plans and insurance payor
representatives to support successful enrollment outcomes
• Partner cross-functionally with internal stakeholders, including:
o Revenue Cycle Management: Resolve billing issues related to credentialing
status and enrollment gaps
o Payor Relations: Align on timely execution of payor contracts to support
accurate enrollment submissions
• Proactively identify, analyze, and resolve enrollment gaps, delays, and risks
impacting practice operations and revenue cycle performance
• Ensure strict compliance with all applicable state and federal regulations, including
Medicare and Medicaid requirements
• Contribute to team initiatives focused on enrollment cleanup, process
improvement, and operational efficiency
• Perform additional credentialing, compliance, and operational support duties as
assigned
Minimum Qualifications / Requirements
• Minimum of 2 years of direct provider enrollment and credentialing experience
required
• 2–3 years of administrative experience in a healthcare environment preferred
• Working knowledge of Medicare, Medicaid, and commercial payor enrollment
processes
• Well versed within CAQH, NPPES, PECOS, and payor portals (e.g., Availity, One
HealthCare ID, etc.)
• High School diploma or GED required (Associate’s or Bachelor’s degree preferred)
• Strong organizational skills with exceptional attention to detail
• Ability to manage multiple priorities, deadlines, and competing demands in a fastpaced
environment
• Excellent communication, interpersonal, problem-solving, and critical thinking
skills
• Ability to work independently with minimal supervision while maintaining
accountability
• Comfortable working in a remote environment with video-based collaboration
Key Competencies
• Customer-focused with a high level of professionalism
• Strong follow-through and accountability
• Adaptability and resourcefulness in problem-solving
• Cross-functional collaboration and relationship-building
• Process-driven with a focus on accuracy and compliance