Medical Credentialing Specialist

Job Title: Medical Credentialing SpecialistLocation: Elkridge, MDEmployment Type: Full timeDepartment: Revenue Cycle / Provider EnrollmentJob Summary:The Medical Credentialing Specialist is responsible for end-to-end provider and facility credentialing and recredentialing with commercial insurance carriers, Medicare, Medicaid, and managed care organizations. This role ensures medical providers, ambulatory surgery centers (ASCs), and medical offices are properly enrolled and maintained as in-network participants to support timely reimbursement and regulatory compliance.Key Responsibilities:Manage initial credentialing, recredentialing, and ongoing enrollment for:Physicians and non-physician providersAmbulatory Surgery Centers (ASCs)Medical practices and facilitiesComplete and submit provider and facility applications to:Commercial insurance carriersMedicare and MedicaidManaged care organizations and third-party administratorsMaintain accurate provider and facility records in CAQH, PECOS, and payer portalsTrack application status and proactively follow up with payers to ensure timely approvalCoordinate with providers, office staff, and credentialing committees to obtain required documentation, including:Licenses and certificationsMalpractice insuranceBoard certificationsFacility accreditations (AAAASF, AAAHC, Joint Commission, etc.)Ensure compliance with payer requirements, state regulations, and internal policiesMonitor credentialing timelines and maintain recredentialing schedules to prevent network lapsesCommunicate credentialing status and issues to internal stakeholdersMaintain organized credentialing files and audit-ready documentationAssist with contract loading verification and payer demographic updatesSupport payer audits and revalidation requests as neededRequired Qualifications:Minimum 2 years of medical credentialing experienceHands-on experience credentialing:Medical providersAmbulatory surgery centers (ASCs)Medical practices/facilitiesStrong knowledge of:CAQH ProViewPECOSMedicare and Medicaid enrollmentCommercial payer credentialing processesFamiliarity with provider enrollment timelines and payer requirementsExcellent organizational and follow-up skillsStrong written and verbal communication skillsAbility to manage multiple credentialing files simultaneouslyHigh attention to detail and accuracyPreferred Qualifications:Experience with multi-state credentialingKnowledge of payer contracting and fee schedulesExperience with credentialing software or practice management systemsUnderstanding of revenue cycle workflowsHealthcare administration or related degreeSkills & Competencies:Provider and facility credentialingInsurance enrollment and payer relationsRegulatory complianceTime management and prioritizationProblem-solving and follow-throughConfidentiality and HIPAA complianceCompany DescriptionJohnson Consulting LLC is a health care based consulting firm specializing in managing multiple different types of medical specialities for private practices. We currently consult for multiple firms, with the number of locations coming in at almost 50 across 4 different states. We are continuously growing and have recently been rated by Healthcare Business Review as one of the top ten medical practice management firms in the country. We offer a number of different services that our client utilize for their own private practice, including the following: access to capital, project management, practice management, operations expertise, long-term strategy and implementation, ancillary service management, outsourced CFO work, vendor management, and consulting. We have a team of highly experienced business and medical professionals who have been in their respective fields for years. This is why we have recently been named one of the top ten management firms in the country and we are continously growing every single year!

Salary : $20 - $22