Credentialing and Provider Enrollment Specialist

General Summary

The Credentialing and Provider Enrollment Specialist oversees all aspects of provider credentialing, re-credentialing, payer enrollment, hospital privileging, and onboarding processes. This role ensures regulatory compliance and uninterrupted reimbursement by coordinating with multiple commercial and government payers, as well as hospital systems. The specialist supports Center for Neurosciences providers and manages onboarding for physicians and advanced practice providers, ensuring timely and accurate processing of all credentialing and enrollment requirements.

Essential Duties and Responsibilities

• Manage initial credentialing and re-credentialing for all providers.
• Submit and track applications with all payers (Medicare, AHCCCS, commercial plans).
• Maintain CAQH profiles (attestations every 120 days).
• Process applications for appointment and reappointment of privileges for all hospitals.
• Maintain close communication with clinicians to ensure that records are up-to-date and consistent.
• Maintain copies of current state licenses, DEA certificates, malpractice coverage and any other required credentialing documents for all providers.
• Tracks license and certification expirations for all clinicians to ensure timely renewals.
• Ensure documents and applications are signed by the clinicians in a timely manner.
• Other duties as assigned.

Required

• 2-5 years medical credentialing experience (multi-provider group preferred) or any equivalent combination of experience, training and/or education approved by the Patient Access Manager and/or Human Resources.
• Strong knowledge of Medicare, AHCCCS, and commercial payer enrollment.
• Experience with hospital privileging processes.
• Proficiency with CAQH, PECOS, and payer portals.

Preferred

• Strong organizational skills and deadline management experience
• CPCS certification