Credentialing Enrollment Specialist
Core
Support healthcare provider credentialing and network enrollment operations by ensuring applications are accurate, complete, and compliant with health plan accreditation standards before submission.
Role type
Operational Credentialing Specialist
Builds
Provider network participation and compliance with health plan accreditation standards
Domain
Healthcare administration / Insurance operations
Deliverable
dashboards & analysis
Required skills
Primary source verification, CAQH management, compliance with accreditation standards, data entry, communication with providers, regulatory interpretation
Preferred skills
Health insurance operational experience, medical terminology knowledge
Technologies
CAQH, internal credentialing platforms, standard business applications
Responsibilities
Review provider credentialing applications for accuracy and compliance; Contact providers to obtain missing information and update CAQH applications; Conduct primary source verifications (licenses, sanctions, liability coverage); Educate providers on credentialing procedures and documentation requirements; Enter and maintain provider information in credentialing systems; Monitor and assign incoming paper applications
Seniority
Entry-level to Junior, hands-on IC