Position Details
About this role
Payer Credentialing Specialist to manage end-to-end credentialing for providers across multiple payers. Ensure compliance with NCQA, CMS, and payer standards, maintain credentialing records, and support audits and enrollment processes.
Key Responsibilities
- Manage end-to-end credentialing and recredentialing processes for new and existing providers
- Coordinate payer enrollment applications and updates
- Maintain credentialing files in compliance with standards
- Collaborate with providers, health plans, and internal departments
- Track credentialing timelines and follow up on outstanding documentation
Technical Overview
Utilizes credentialing platforms CAQH, NPPES, PECOS; ensures regulatory compliance and accurate data management across payer enrollment workflows.
Ideal Candidate
The ideal candidate is a healthcare credentialing specialist with 2+ years of experience, strong knowledge of CAQH/NPPES/PECOS, and a proven ability to maintain accurate credentialing records while ensuring regulatory compliance. They are detail-oriented, communicative, and comfortable working independently in a fast-paced environment.
Must-Have Skills
Nice-to-Have Skills
Tools & Platforms
Required Skills
Hard Skills
Soft Skills
Industry & Role
Keywords for Your Resume
Deal Breakers
Less than 2 years credentialing experience, No knowledge of CAQH/NPPES/PECOS, Inability to work independently
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