Provider Credentialing Specialist

Duration: 6 months to start

Job Description:
Key Responsibilities:

• Process and track initial payer credentialing, provider enrollment, recredentialing, and revalidation applications for participating providers.
• Support behavioral health provider enrollment and credentialing, including collecting and reviewing payer-required documentation.
• Prepare, assemble, review, and quality-check provider applications; follow up with providers and payers to resolve missing or inconsistent information.
• Conduct credential verification and mandated queries as assigned, in accordance with policies and applicable payer requirements.
• Enter, review, maintain, and update provider information in credentialing databases, CAQH, and payer systems.
• Cleanse and validate credentialing/provider records to support the MD-Staff transition, identifying incomplete, outdated, or inconsistent data and coordinating corrections.
• Monitor provider expirables, enrollment status, recredentialing deadlines, and payer revalidation cycles; maintain accurate documentation and status tracking.
• Communicate with providers, practice managers, medical staff offices, and payer representatives to facilitate timely credentialing and enrollment.
• Prepare reports and updates for downstream billing/system maintenance; support resolution of enrollment-related claim issues.
• Protect confidential provider information and follow organizational privacy, compliance, and quality procedures.
• Perform other related duties as assigned.

Preferred Experience

• Independent end-to-end payer enrollment: preparing and submitting applications, tracking payer responses, resolving deficiencies, and maintaining provider participation records.
• Behavioral health provider credentialing/enrollment; experience with specific provider types and payer requirements.
• Credentialing data cleansing, duplicate/incomplete record resolution, data validation, reconciliation, and quality checks for a system transition, ideally involving MD-Staff.
• Hands-on Cactus or MD-Staff; both systems preferred.
• Initial credentialing, recredentialing, primary source verification, NPDB queries, CAQH profile maintenance/re-attestation, and Medicare/Medicaid revalidations.

Required Qualifications
Education:

• High School Diploma or GED required
• Associate degree preferred

Experience:

• Minimum 2 years of relevant experience required.
• Direct, hands-on payer credentialing and provider enrollment experience is strongly preferred, particularly in behavioral health.

Certifications:

• Certified Provider Credentialing Specialist (CPCS) preferred

Technical Skills:

• Proficient computer and data-entry skills
• Ability to maintain accurate credentialing/provider records and work with electronic systems.
• Experience with Cactus, MD-Staff, CAQH, and payer portals strongly preferred as applicable.

Other Requirements:

• Strong attention to detail
• Organizational skills
• Confidentiality
• Independent workload management
• Clear communication with providers, practices, payers, and internal teams.

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