Credentialing & Contracting Specialist

Job Summary
We are seeking an experienced Credentialing & Contracting Specialist to manage provider credentialing, payer enrollment, recredentialing, and insurance contracting across multiple states, with a primary focus on West Virginia and Ohio. The ideal candidate will have hands-on experience with Medicare, Medicaid, Managed Medicaid, and commercial insurance carriers and be comfortable independently managing credentialing and contracting processes from application through effective date.

Key Responsibilities

• Complete provider and facility credentialing, enrollment, and recredentialing.
• Manage Medicare, Medicaid, Managed Medicaid, and commercial payer applications.
• Maintain CAQH, PECOS, NPPES, Availity, and payer portals.
• Manage provider additions, terminations, demographic changes, and reassignments.
• Track licenses, malpractice insurance, certifications, and credentialing expirations.
• Submit and track payer contracting and network participation requests.
• Maintain payer contracts, fee schedules, amendments, and provider rosters.
• Follow up with insurance carriers and resolve enrollment or contracting issues.
• Work with Billing, Revenue Cycle, Compliance, and Operations to prevent credentialing-related claim delays.
• Maintain accurate, organized, and audit-ready credentialing records.

Qualifications

• 3–5 years of healthcare credentialing, payer enrollment, and/or contracting experience required.
• Strong experience with Medicare, Medicaid, and commercial insurance.
• Multi-state credentialing experience; West Virginia and/or Ohio experience strongly preferred.
• Experience with CAQH, PECOS, NPPES, and Availity.
• Knowledge of NPIs, Tax IDs, taxonomy codes, Medicare enrollment, Medicaid enrollment, and payer credentialing requirements.
• Behavioral health or substance use disorder treatment experience preferred.
• Strong organizational, communication, follow-up, and problem-solving skills.
• Ability to independently manage multiple providers, payers, applications, and deadlines.

Preferred Payer Experience: UnitedHealthcare/Optum, Aetna, Cigna/Evernorth, Highmark/BCBS, Molina, CareSource, Buckeye Health Plan, and other regional or national payers.

Join our team as a Credentialing & Contracting Specialist to play a key role in maintaining the integrity of our provider network while supporting our mission to deliver compliant, high-quality healthcare services!

Benefits:

• 401(k)
• Dental insurance
• Health insurance
• Paid time off
• Vision insurance

Work Location: Hybrid remote in Parkersburg, WV 26101

Salary : $42,041 - $59,508