What you’ll be doing:

Schedule: This position is expected to work Monday–Friday, 8 hours per day. Candidates who are available to work during Central Time (CT/CST) business hours are preferred, though qualified candidates from other U.S. time zones who can support the required schedule will be considered.

The Payor Credentialing Specialist performs duties associated with payor enrollment, credentialing, re-credentialing, and privileging network providers.

Essential duties and responsibilities:

• Coordinate the credentialing, recredentialing, and provider enrollment process for physicians, advanced practice providers, and allied health professionals
• Complete, review, and submit credentialing and enrollment applications to Medicare, Medicaid, commercial insurance carriers, and managed care organizations
• Monitor application status, follow up with payors, and resolve deficiencies to ensure timely provider enrollment
• Verify provider credentials, including licensure, education, training, certifications, work history, malpractice coverage, and other required documentation
• Maintain provider records in credentialing databases: MD Staff, CAQH, PECOS, NPPES, and other applicable systems, enabling tracking of credential expiration dates and maintenance of audit-ready files
• Coordinate with providers and internal departments to obtain required documentation and respond to requests from payors for additional information
• Research and resolve credentialing and enrollment issues affecting provider participation and reimbursement
• Generate credentialing reports, maintain enrollment status reports, and support internal and external audits
• Ensure compliance with federal and state regulations, accreditation standards, HIPAA, and organizational policies; communicate credentialing status updates to leadership and providers
• Participate in process improvement initiatives

Must haves:

• High school or GED (required)
• Strong organization skills. Detail oriented. Ability to multi-task and prioritize (required)
• Able to communicate in a professional manner both verbally and in writing (required)
• Minimum of 3 years of experience in healthcare facility credentialing and physician credentialing (required)

Bonus qualities:

• Bachelor’s degree in business, healthcare or any related field of study (preferred)
  • Equivalent years of experience (in addition to requirement) may be substituted for degree
• Certified Provider Credentialing Specialist (CPCS) or Certified Provider Enrollment Specialist (CPES) by the National Association of Medical Staff Services (NAMSS) (preferred)
• Experience utilizing MD Staff Software (preferred)

Location: This position is posted as remote; however, per company policy, candidates residing within a 35‑mile radius of ZIP code 80230 will be required to follow a hybrid schedule (3 days/week onsite), even if they applied to the remote posting.

The compensation range for this position is based upon candidate experience and market expectations.