What are the responsibilities and job description for the Payer Credentialing Specialist position at WoundCentrics and Careers?
We are a dynamic and growing medical group dedicated to delivering high-quality patient care through excellence in operations and compliance. We are seeking a skilled Payer Credentialing Specialist to join our team. This role focuses exclusively on payer enrollment and contract maintenance for our physicians and advanced practice providers.
Position Overview:
The Payer Credentialing Specialist will oversee all aspects of provider enrollment, payer applications, and maintenance across commercial and government insurance plans. The ideal candidate has a deep understanding of payer credentialing workflows, insurance plan requirements, and timeline management, ensuring seamless participation and timely reimbursement for our providers.
Key Responsibilities:
- Manage end-to-end payer enrollment and recredentialing for all providers within the medical group.
- Prepare, submit, and track applications with commercial and government payers (Medicare, Medicaid, BCBS, Aetna, Cigna, UnitedHealthcare, etc.).
- Maintain accurate provider records in CAQH, NPPES, PECOS, Availity, and other payer portals.
- Coordinate with internal teams to ensure alignment between credentialing, contracting, and billing operations.
- Track and manage effective dates, payer IDs, and credentialing expirables to prevent lapses in participation.
- Resolve payer-related credentialing issues and follow up to ensure timely approvals.
- Maintain compliance with payer-specific requirements and state/federal regulations.
- Assist in payer audits and compliance reviews related to credentialing.
Qualifications:
- Minimum 5 years of payer credentialing experience in a medical group, MSO, or healthcare organization.
- Deep understanding of payer enrollment processes and credentialing best practices.
- Experience with CAQH, PECOS, and payer portals (e.g., Availity).
- Familiarity with HIPAA and CMS regulations.
- Strong attention to detail, organization, and follow-up.
- Excellent written and verbal communication skills.
- CPCS or CPMSM certification preferred.
Why Join Us:
- Competitive salary and benefits package
- Flexible work environment (remote/hybrid options available)
- Collaborative and supportive team culture
- Opportunity to work in a compliance-driven, growth-oriented organization