Provider Credentialing Specialist
RemoteUnited States
Job Summary
Prepare and submit provider credentialing and payer enrollment applications while collecting, reviewing, and maintaining provider documentation including licenses and certifications. Verify credentials to ensure required documentation remains current, then track applications, approvals, expirations, and recredentialing deadlines. Follow up with insurance payers and credentialing organizations regarding application status and maintain accurate provider records in internal systems. Identify missing or inconsistent information and work with provider teams to resolve documentation issues, supporting updates to practice locations, specialties, and payer participation while following established privacy and compliance procedures. This role supports provider clients with enrollment activities to ensure they remain properly enrolled and eligible to participate with applicable insurance plans.
Required Qualifications
- 1+ year of experience in provider credentialing, payer enrollment, medical administration, or a related healthcare role
- Understanding of provider credentialing and payer enrollment processes
- Experience working with insurance payers, credentialing organizations, or provider networks
- Strong attention to detail and ability to manage multiple applications, deadlines, and follow-ups
- Experience reviewing and maintaining professional licenses, certifications, and provider documentation
- Strong organizational and time-management skills
- Ability to communicate effectively with providers, payer representatives, and internal teams
- Ability to work independently and effectively in a fully remote environment
- HIPAA-compliant private workspace
Desired Qualifications
- Experience with CAQH and other provider credentialing or enrollment platforms
- Experience with Medicare, Medicaid, or commercial payer enrollment
- Knowledge of NPI, taxonomy codes, and provider enrollment requirements
- Experience with hospital or multi-specialty provider credentialing
- Familiarity with Epic, Athena, eClinicalWorks, or other healthcare systems
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