Position Summary
NxGen MDx is seeking a detail-oriented Credentialing Specialist to support provider, payor, and facility credentialing activities. This role will help manage payer enrollment, recredentialing, provider data maintenance, and follow-up with commercial payers, Medicare, Medicaid, and other healthcare entities. The ideal candidate has 2-3 years of healthcare credentialing, provider enrollment, medical billing, or revenue cycle experience and understands the importance of accuracy, compliance, and timely payer communication.
Key Responsibilities
- Manage credentialing and recredentialing applications for providers, facilities, and laboratory-related
- payor enrollments.
- Prepare, submit, and track payer enrollment applications with commercial insurance plans, Medicare,
- Medicaid, and managed care organizations.
- Maintain accurate credentialing files, including licenses, certifications, malpractice coverage, CLIA/CAP-
- related documentation when applicable, W-9s, ownership information, and payer-specific forms.
- Follow up with payers regularly to confirm application status, missing items, approval timelines, effective
- dates, and contract participation status.
- Update and maintain internal credentialing trackers, payer rosters, provider data, and enrollment
- records.
- Coordinate with Revenue Cycle, Billing, Finance, Compliance, Sales Support, and Operations to resolve
- credentialing-related billing or enrollment issues.
- Assist with payer audits, provider data validation, and documentation requests.
- Monitor expiring licenses, certifications, insurance documents, and other required credentials.
- Help identify credentialing barriers that may delay claims payment, enrollment approval, or payer
- participation.
- Maintain confidentiality and ensure compliance with HIPAA and company policies
Qualifications
- 2-3 years of experience in healthcare credentialing, payer enrollment, provider enrollment, medical
- billing, or revenue cycle operations preferred.
- Experience working with commercial payers, Medicare, Medicaid, or managed care organizations.
- Strong attention to detail and ability to manage multiple applications and deadlines at once.
- Comfortable following up with payers by phone and email.
- Proficient with Excel, shared trackers, payer portals, and healthcare documentation.
- Strong written and verbal communication skills.
- Ability to work independently while coordinating with cross-functional teams.
- Laboratory, women's health, diagnostics, physician practice, or medical billing company experience is a plus.
Preferred Skills
- Familiarity with CAQH, PECOS, NPPES, Availity, Medicaid portals, and commercial payer enrollment
- platforms.
- Understanding of credentialing, contracting, payer enrollment, claims delays, and revenue cycle impact.
- Experience maintaining provider or facility credentialing files.
- CPCS, CPMSM, or other credentialing certification is a plus but not required.
Success Measures
- Timely submission and follow-up of payer enrollment and credentialing applications.
- Accurate and complete credentialing files.
- Reduction in payer enrollment delays or credentialing-related claim issues.
- Clear visibility into application status, effective dates, and outstanding payer requests.
- Strong communication with Revenue Cycle, Finance, and Operations teams.
NxGen MDx is an equal opportunity employer. We consider qualified applicants without regard to race, color, religion, sex, national origin, age, disability, veteran status, or any other legally protected status.
Job Type: Full-time
Pay: $24.00 - $30.00 per hour
Benefits:
- 401(k)
- Dental insurance
- Health insurance
- Life insurance
- Paid time off
- Vision insurance
Work Location: Remote
