Job Description Summary

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The Credentialing & Enrollment Specialist is responsible for coordinating and maintaining provider credentialing and enrollment activities to ensure compliance with organizational, regulatory, and health plan requirements. This role manages initial credentialing and recredentialing inventories, supports provider enrollment processes, conducts outreach for missing documentation, communicates credentialing decisions, and serves as a liaison between providers, network partners, and internal stakeholders. The position requires strong organizational skills, attention to detail, proficiency in Microsoft Excel, and excellent written and verbal communication skills.

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How will you make an impact & Requirements

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Manage and maintain assigned initial credentialing and recredentialing inventories to ensure timely completion and compliance with established turnaround times.
Review credentialing and enrollment applications for completeness and accuracy.
Conduct outreach to providers, provider groups, and internal stakeholders to obtain missing or required documentation.
Track and monitor credentialing and enrollment status through various systems and reports.
Communicate credentialing approvals, denials, and status updates to providers and internal business partners.
Support provider enrollment activities with government and commercial payers.
Maintain accurate provider records, files, and databases.
Monitor shared departmental email inboxes and respond to inquiries in a timely and professional manner.
Collaborate with network partners, health plans, provider offices, delegated entities, and internal departments to resolve credentialing and enrollment issues.
Prepare and maintain Excel spreadsheets, tracking logs, and reports for operational and audit purposes.
Ensure compliance with NCQA, CMS, state regulatory, and organizational credentialing requirements.
Assist with credentialing audits, data validation, and special projects as assigned.
Escalate complex issues and aging inventory items as appropriate.

Required Education and Experience

High school diploma or equivalent required; Associate's or Bachelor's degree preferred.
Minimum of 2 years of healthcare credentialing and/or provider enrollment experience.
Experience working with health plans, provider groups, or managed care organizations preferred.
Knowledge of provider credentialing, recredentialing, and enrollment processes.

Knowledge, Skills, and Abilities

Strong proficiency in Microsoft Excel, including sorting, filtering, reporting, and data management.
Excellent verbal and written communication skills.
Strong attention to detail and organizational skills.
Ability to manage multiple priorities and meet deadlines in a fast-paced environment.
Experience maintaining shared mailboxes and managing high-volume communications.
Ability to work independently and collaboratively with cross-functional teams.
Customer service oriented with strong problem-solving skills.
Knowledge of credentialing regulations, accreditation standards, and provider data management preferred.

Preferred Experience

Experience with NCQA credentialing standards.
Experience with provider enrollment systems, CAQH, PECOS, NPPES, Availity, and state Medicaid enrollment portals.
Experience supporting delegated credentialing or managed care network operations.

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Compensation Range:

$24.20

$43.56

The anticipated base salary range represents the Company's good-faith estimate of the compensation it reasonably expects to pay for this position at the time of posting. Actual compensation will be determined based on factors including experience, skills, qualifications, geographic location, internal equity, and business needs.

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