What are the responsibilities and job description for the Credentialing Specialist position at Worthy Billing and Consulting?
Credentialing and Enrollment Specialist
Position Summary
The Credentialing and Enrollment Specialist is responsible for managing the credentialing, recredentialing, and payer enrollment processes for healthcare providers. This role ensures providers are properly credentialed, enrolled, and maintained with insurance payers in a timely and accurate manner to support uninterrupted reimbursement and compliance with payer and regulatory requirements.
Key Responsibilities
Credentialing
- Complete initial and recredentialing applications for providers with insurance payers, hospitals, and other entities.
- Gather, verify, and maintain all required provider documentation, including licenses, certifications, DEA, NPI, malpractice insurance, and CAQH profiles.
- Monitor credentialing status and follow up with payers to ensure timely approval.
- Track credentialing and recredentialing deadlines to prevent lapses in provider participation.
- Maintain accurate credentialing records and databases.
Provider Enrollment
- Enroll providers with commercial, Medicare, Medicaid, and other insurance plans.
- Update provider enrollments for changes such as practice location, tax ID, ownership, or demographics.
- Submit and track payer enrollment applications and resolve enrollment-related issues or denials.
- Ensure providers are active and correctly linked to group and individual contracts.
Compliance & Accuracy
- Ensure credentialing and enrollment processes comply with payer requirements, state and federal regulations, and internal policies.
- Identify and correct discrepancies or missing information that may delay approval or payment.
- Maintain confidentiality of provider and patient information in accordance with HIPAA regulations.
Communication & Coordination
- Communicate credentialing and enrollment status updates to internal teams and providers.
- Serve as a point of contact for payers regarding credentialing and enrollment inquiries.
- Collaborate with billing, operations, and leadership teams to resolve issues impacting claims or reimbursement.
Reporting & Tracking
- Maintain spreadsheets or credentialing software to track application status, approvals, expirations, and follow-ups.
- Provide regular status reports on credentialing and enrollment progress.
- Assist with audits or payer reviews as needed.
Qualifications
Required
- High school diploma or equivalent (Associate’s or Bachelor’s degree preferred).
- 3-5 years of experience in provider credentialing and/or insurance enrollment.
- Knowledge of commercial insurance, Medicare, and Medicaid enrollment processes.
- Familiarity with CAQH, NPPES, PECOS, and payer portals.
- Strong attention to detail and organizational skills.
- Ability to manage multiple providers and deadlines simultaneously.
- Excellent written and verbal communication skills.
Preferred
- Experience in medical billing, revenue cycle management, or healthcare administration.
- Credentialing experience for behavioral health, ABA, or multi-specialty practices.
- Experience working remotely and independently.
- Knowledge of state-specific payer requirements.
Skills & Competencies
- Time management and prioritization
- Problem-solving and follow-through
- Documentation and record accuracy
- Professional communication
- Confidentiality and compliance awareness
Work Environment
- Remote
- Full-time position
- Requires prolonged computer use and frequent interaction with payer portals
Job Type: Full-time
Pay: $18.00 - $22.00 per hour
Expected hours: 40 per week
Benefits:
- Paid time off
- Retirement plan
People with a criminal record are encouraged to apply
Work Location: Remote
Salary : $18 - $22