Credentialing Specialist

Roles & Responsibilities

Voice Process / Semi-Voice Process

• Contact insurance payers to verify credentialing and enrollment status.
• Follow up on pending credentialing and re-credentialing applications.
• Communicate with providers regarding missing documents and application updates.
• Resolve credentialing-related issues through phone calls and emails.
• Maintain detailed call logs and updates in the credentialing system.
• Coordinate with insurance representatives to expedite applications.
• Process provider credentialing and enrollment applications.
• Complete CAQH profile updates and attestations.
• Prepare, submit, and track payer enrollment requests.
• Maintain provider files, licenses, certifications, and supporting documents.
• Monitor credentialing expirations and ensure timely renewals.
• Handle email communication with providers and payers.
• Update credentialing databases and generate status reports.

Required Skills

• Knowledge of US Healthcare Credentialing and Provider Enrollment.
• Experience with CAQH, Medicare, Medicaid, and Commercial Payers.
• Strong communication and interpersonal skills.
• Good analytical and problem-solving abilities.
• Proficiency in MS Office, especially Excel.
• Ability to manage multiple tasks and meet deadlines.
• Excellent documentation and follow-up skills.