Job Description

Job Description

Job Description

The Medical Credentialing Specialist is responsible for coordinating, processing, and maintaining provider credentialing and recredentialing activities to ensure compliance with payer, state, and federal requirements. This role supports the overall provider network by ensuring timely enrollment, accurate data management, and adherence to internal and external credentialing standards. The specialist will maintain strong working knowledge of payer and provider enrollment processes to ensure seamless participation and reimbursement for all providers across the organization’s operational states. Responsibilities

• Manage the full cycle of credentialing and recredentialing for all providers within assigned regions and payer networks.
• Prepare, complete, and submit applications for payer and provider enrollment, ensuring compliance with payer requirements and deadlines.
• Maintain accurate provider data in credentialing databases and tracking systems (CAQH, NPPES, PECOS, Availity, payer portals, etc.).
• Review, verify, and validate provider credentials including licenses, certifications, malpractice coverage, education, training, and work history.
• Track application status and proactively follow up with payers, providers, and internal departments to ensure timely approval.
• Collaborate with Revenue Cycle and Network Relations teams to ensure credentialing aligns with billing and contracting timelines.
• Maintain documentation of credentialing files and participate in internal or external audits as needed.
• Monitor expiring documents and licenses to ensure continued compliance and revalidation with all payers.
• Stay current with changes in payer policies, credentialing standards, and regulatory requirements.
• Assist with process improvements and cross-training initiatives to enhance departmental efficiency.

Required Skills Education & Experience

• Associate’s degree or equivalent experience in healthcare administration, business, or a related field required.
• Minimum of 2–3 years of experience in medical credentialing, recredentialing, or payer enrollment.
• Knowledge of Medicaid enrollment processes required.
• Experience working with CAQH, NPPES, PECOS, NPDB, Availity, and payer portals.

Skills & Competencies

• Strong understanding of credentialing standards and payer enrollment requirements.
• Excellent organizational and time-management skills with the ability to manage multiple priorities.
• High attention to detail and accuracy in data entry and document verification.
• Proficiency in Microsoft Office Suite (Word, Excel, Outlook) and credentialing databases.
• Strong written and verbal communication skills.
• Ability to maintain confidentiality and handle sensitive provider information.

Preferred Qualifications

• CPCS or CPMSM certification (through NAMSS) preferred.
• Previous experience with multi-state or multi-specialty healthcare organizations.

Network Requirements
High-speed internet with a minimum download speed of 25 Mbps and a minimum upload speed of 5 Mbps

OFFOR Health Benefits
OFFOR Health currently offers full competitive employee benefits including medical, dental and vision insurance, LTD, STD and Group Life insurance, 401(k) retirement plan, flexible time off and paid holidays.

OFFOR Health does not discriminate on the basis of actual or perceived race, religion, color, national origin, ancestry, disability, medical condition, marital status, sex, age, sexual orientation, gender identity or expression, family responsibility, personal appearance, genetic information, matriculation, political affiliation, or any other status protected under law.

Job Tags

Work at office, Flexible hours,

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