Job Summary
The Credentialing Specialist will be responsible for coordinating all aspects of the provider credentialing and recredentialing process to ensure providers are enrolled in health plans and remain compliant with regulatory, payer, and organizational requirements. This role plays a key part in ensuring providers and practices are successfully onboarded, enrolled with insurance payers, and maintained within network and credentialing systems. This is a hybrid remote role with onsite presence required for meetings, trainings, and other business needs.
Responsibilities
- Coordinate credentialing and enrollment activities to ensure providers are credentialed with commercial and Medicare plans
- Research and resolve discrepancies or missing information within provider files
- Maintain accurate provider information in credentialing systems, tracking reports, CAQH and other applicable databases
- Track credentialing and enrollment activities and provide timely status updates to applicable stakeholders
- Prepare, submit, and track Medicare enrollment applications through the PECOS portal
- Manage and coordinate hospital privilege applications and renewals, ensuring required documentation is obtained and submitted within established deadlines
- Serve as a liaison between providers, hospitals, medical staff offices, practices, and internal teams
- Facilitate regular status meetings with practices
- Research, facilitate, and resolve payer issues involving contracting, enrollment, billing, and network participation
Qualifications
- Associates degree or equivalent combination of education and relevant work experience. Bachelor's degree preferred.
- 2+ years of experience in healthcare credentialing, provider enrollment, medical staff services, or a related healthcare administrative role
- Knowledge of CAQH, NPPES, PECOS, and electronic signature platforms preferred
- Strong knowledge of healthcare provider documentation and verification requirements
- Ability to manage multiple priorities, deadlines, and provider files simultaneously
- Ability to work independently while collaborating effectively with providers, practices, and internal team members
- Proficiency with Microsoft Office, Excel, and credentialing databases or tracking systems
- AI experience a plus
- Ability to communicate clearly and professionally with providers, practices, insurance companies, hospitals, and stakeholders
Benefits
- Medical, Dental, and Vision insurance
- 401K with matching
- Health savings account
- Flexible spending account
- Paid Time Off
- Tuition reimbursement
- Life insurance
- Employee Assistance Plan
Pay: $57,000.00 - $67,000.00 per year
Benefits:
- 401(k)
- 401(k) matching
- Dental insurance
- Employee assistance program
- Flexible spending account
- Health insurance
- Health savings account
- Life insurance
- Paid time off
- Parental leave
- Referral program
- Retirement plan
- Tuition reimbursement
- Vision insurance
Work Location: Hybrid remote in Plano, TX 75024
