Provider Enrollment/Credentialing Specialist

Job scope:  Performs all aspects of health plan related individual provider and facility enrollment, credentialing, and re-credentialing activities. Responsible for ensuring providers are enrolled/credentialed, appointed, and privileged with health plans including but not limited to; Medicare, Medicaid, Medicaid Managed Care, CHIP and Commercial Insurance. Responsible for maintaining center CAQH / Availity practice accounts and ensuring that all applicable individual licensed providers have a current active CAQH / Availity account. Maintains up to date credentialing related processes and data for center facility and individual provider contracts in accordance with all established center, state, federal, Joint Commission and other regulatory and accreditation bodies.  Implements and manages a detailed tracking system for completed and pending enrollment/credentialing assignments.  Maintains up to date, complete and accurate files of all required facility and individual provider enrollment/credentialing related information. Responsible for updating and maintaining provider directories for all health plans.  Acts as Center liaison with all health plans and other Insurance entities to ensure the Center is in compliance with contractual credentialing requirements. Works closely with center insurance/reimbursement department on all credentialing related billing issues.


High School Diploma or GED required. 3 - 5 years' experience in healthcare credentialing will be considered in lieu of degree

Current valid driver's license in state of residence.


Experience with regulatory standards (e.g. The Joint Commission, NCQA)(preferred)

Excellent Communications Skills, Excellent Interpersonal Skills, General Clerical Skills, Ability to interact with all levels of the organization.

Strong computer skills requested with proficiency in Excel, PowerPoint and Word processing experience

Ability to respect and maintain confidentiality of all information

Analytical Thinking: Ability to Identify issues, obtain relevant information, relate and compare data from different sources, and identify alternative solutions.

Attention to Detail: Achieves thoroughness and accuracy when accomplishing a task.

Written Communication: Ability to organize and express information and ideas in written form to individuals as well as groups

Construct messages that are clear and convincing

Physical requirements that are bona fide occupational qualifications essential to the performance of the job:

Moderate lifting and carrying up to a maximum of 35 pounds.  Sitting for prolonged periods, walking, bending, stooping, kneeling, and reaching above shoulder height.  Fine Motor skills necessary to operate essential office equipment.  Ability to read and visual acuity to decipher printed information at 8 lines per inch.  Work site is inside office environment.