Medical Credential Expert (Insurance)

Job Summary:
We are seeking a detail-oriented Provider Credentialing & Enrollment Specialist to manage end-to-end credentialing, payer enrollments, and compliance processes for healthcare providers. This role ensures accurate documentation, timely submissions, and adherence to state and federal regulations while coordinating closely with clinics, providers, and insurance payers.

Key Responsibilities:

Oversee initial credentialing and re-credentialing of providers, including CAQH profile maintenance, license tracking, and audit-ready documentation

Manage payer enrollment applications and provider packets for Medicare, Medicaid, and commercial insurance plans

Track credentialing and enrollment status, follow up with payers, and resolve delays or issues

Maintain credentialing databases, files, and records with high accuracy and organization

Coordinate with clinics and providers to obtain required documents and verify information

Monitor license expirations, renewals, and compliance deadlines

Ensure compliance with state and federal regulations and internal policies

Qualifications:

1–3+ years of experience in provider credentialing, enrollment, or healthcare administration

Familiarity with CAQH, Medicare, Medicaid, and commercial payer processes

Strong attention to detail and organizational skills

Excellent written and verbal communication skills

Ability to manage multiple deadlines and follow up proactively

Proficiency in spreadsheets, credentialing software, and document management systems

Preferred:

CPCS, CPMSM, or related certification

Experience working with multi-state providers or telehealth groups

Work Setup:

Remote

Full-time | Monday–Friday

What We Offer:

Competitive compensation

Opportunities for growth and certification support

Collaborative and fast-paced healthcare environment

This role is ideal for someone who thrives on accuracy, process ownership, and keeping provider operations running smoothly.