Provider Credentialing Specialist

Description

Position Summary

AO Multispecialty Clinic is seeking a detail-oriented and highly organized Provider Credentialing Specialist to support our growing multi-specialty practice. This role is responsible for managing all aspects of provider credentialing, recredentialing, and payer enrollment to ensure compliance with regulatory, accreditation, and payer requirements.

The ideal candidate will have strong knowledge of healthcare credentialing processes, excellent follow-through, and the ability to manage multiple deadlines in a fast-paced medical environment.

Key Responsibilities

· Manage initial credentialing and recredentialing for physicians and advanced practice providers across multiple specialties and locations

· Complete and submit payer enrollment applications for commercial insurance, Medicare, Medicaid, and managed care plans

· Maintain and update provider records within credentialing databases and CAQH profiles

· Monitor credential expiration dates including:

• State licenses
• DEA registrations
• Board certifications
• Malpractice insurance
• Hospital privileges

· Ensure timely revalidation and recredentialing with all payers

· Serve as liaison between providers, payers, hospitals, and internal departments

· Track application status and follow up with insurance carriers to ensure timely approvals

· Maintain compliance with CMS, NCQA, Joint Commission, and payer standards

· Assist Revenue Cycle and Practice Operations teams with enrollment-related billing issues

· Maintain organized electronic credentialing files and audit-ready documentation

Work Environment

· Full-time position

· Office-based role within a collaborative multi-specialty medical practice

· Fast-paced environment supporting oncology, rheumatology, urology, plastic surgery, and radiation therapy services

Benefits

· Competitive compensation

· Health, dental, and vision insurance

· Paid time off and holidays

· Retirement plan options

· Opportunities for professional development

About AO Multispecialty Clinic

AO Multispecialty Clinic is a physician-led healthcare organization serving patients across multiple specialties including Oncology/Hematology, Rheumatology, Urology, Plastic Surgery, and Radiation Therapy. Our team is committed to delivering high-quality care while supporting providers with efficient systems and operational excellence.

Requirements

 Qualifications

· Minimum 2–3 years of provider credentialing and payer enrollment experience required

· Experience credentialing providers in a multi-specialty or multi-location practice preferred

· Working knowledge of Medicare, Medicaid, and commercial payer enrollment processes

· Experience with CAQH, PECOS, and state Medicaid portals required

· Strong attention to detail and ability to manage multiple deadlines

· Excellent communication and organizational skills

· Proficiency with Microsoft Office and credentialing or practice management systems

Preferred Qualifications

· CPCS (Certified Provider Credentialing Specialist) or CPMSM certification

· Experience supporting Revenue Cycle or medical billing operations

· Understanding of how provider enrollment impacts claims submission and reimbursement