Medical Credentialing Specialist

Job Title: Medical Credentialing Specialist

Job Summary:
We are a growing private practice with four surgeons, two office locations, and multiple affiliated facilities seeking an experienced Medical Credentialing Specialist. This role is responsible for managing all aspects of credentialing, payer enrollment, and ongoing compliance, including onboarding a new surgeon to ensure timely participation with all insurance networks and facilities.

Key Responsibilities:

• Manage initial credentialing and re-credentialing for all surgeons, including onboarding of a new provider
• Coordinate credentialing across two office locations and multiple hospitals/ambulatory surgery centers
• Submit, track, and follow up on payer enrollment applications (Medicare and commercial plans)
• Maintain and update provider profiles in systems such as CAQH and payer portals
• Ensure all providers are credentialed and privileged at affiliated facilities
• Maintain accurate records of licenses, board certifications, DEA registrations, malpractice insurance, and hospital privileges
• Track and proactively renew expiring credentials to prevent any disruption in billing or patient care
• Act as the primary liaison with insurance companies, credentialing bodies, and facility medical staff offices
• Partner with billing and administrative teams to resolve credentialing-related claim or reimbursement issues
• Prepare documentation for audits and ensure compliance with regulatory and payer requirements

Qualifications:

• 2+ years of credentialing experience, preferably in a multi-site private practice or surgical setting
• Strong knowledge of payer enrollment processes and facility privileging
• Experience with CAQH and multiple insurance portals required
• Familiarity with Medicare, Medicaid, and commercial payer guidelines
• Ability to manage credentialing across multiple entities and locations

Skills & Attributes:

• Exceptional organization and attention to detail
• Ability to manage multiple timelines and prioritize effectively
• Strong follow-up skills and persistence with payers and facilities
• Clear and professional communication
• Ability to work independently in a small, fast-paced team environment

Work Environment:

• Private surgical practice with two office locations and multiple facility affiliations
• In-office role with some flexibility based on experience