Credentialing Specialist

• Own the end-to-end payer enrollment process for new and existing providers, including initial enrollments, revalidations, demographic updates, terminations, and maintenance across commercial, Medicare, and Medicaid health plans.
• Submit, track, and proactively follow up on payer enrollment applications to ensure timely provider participation and minimize delays to patient care and revenue.
• Serve as the primary point of contact with national and local health plans, delegated credentialing organizations, CVOs, and internal stakeholders to resolve enrollment issues, missing information requests, and payer escalations.
• Maintain accurate provider data across payer portals, CAQH, credentialing systems, and internal tracking tools, ensuring consistency across all platforms.
• Support delegated credentialing activities by maintaining provider rosters, submitting required updates, monitoring compliance requirements, and preparing documentation for internal and external audits.
• Conduct routine audits of provider enrollment and credentialing files to ensure compliance with NCQA, CMS, state, and payer-specific requirements.
• Monitor key enrollment and credentialing metrics, identify risks to provider participation, and communicate status updates and timelines to leadership and cross-functional partners.
• Collaborate closely with Licensing, Practice Operations, Revenue Cycle, Recruiting, and Clinical Operations teams to ensure providers are fully credentialed, enrolled, and ready to see patients on schedule.
• Identify opportunities to improve enrollment and credentialing workflows through process standardization, documentation, automation, and operational efficiencies.
• Support provider licensing activities as needed, including coordinating new state license applications, renewals, cross-licensure efforts, and maintaining accurate licensure records.
• Monitor provider licenses, DEA and CDS registrations, board certifications, malpractice coverage, and other required credentials to ensure continuous compliance.
• Provide exceptional support to providers throughout the enrollment, credentialing, and licensing process by communicating requirements, timelines, and next steps clearly and proactively.

Licensing and Credentialing Specialist managing provider enrollments and compliance at a virtual health practice

Licensing and Credentialing Specialist

Licensing and Credentialing Specialist at Oshi Health managing payer enrollment and compliance. Collaborating with operational teams to ensure providers are credentialed and ready to deliver care.

• Coordinates accurate verification of approximately 8,000 practitioner files for initial appointment and reappointment
• Prepares and sends applications
• Gathers, enters, and verifies information received in the application process
• Communicates verbally and in writing with applicants as necessary to complete their application
• Detail-oriented approach in understanding complex credentialing requirements needed by facility and variances for credentialing in multiple states
• Deadline-driven with the ability to adapt to expedited requests

Credentialing Specialist ensuring accurate verification of practitioner files for Mercy Clinics

Credentialing Specialist coordinating verification of practitioner files for initial and reappointment at Mercy Clinics. Ensuring compliance with accrediting agencies and handling expedited requests.

Credentialing Specialist jobs in Montana

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Licensing and Credentialing Specialist

Credentialing Specialist