Job Description
Credentialing Specialist
Job Summary
The Payer Credentialing Specialist is responsible for coordinating and managing all provider credentialing, enrollment, and re-credentialing activities with third-party payers to ensure timely and accurate claims processing and reimbursement. This position maintains provider enrollment records, submits and tracks payer applications, manages credentialing databases, and serves as a liaison among providers, payers, Physician Billing, Medical Staff, Finance, Information Technology, and other departments. The Payer Credentialing Specialist ensures compliance with payer requirements, NCQA standards, Joint Commission guidelines, and organizational policies while supporting revenue cycle operations through accurate credentialing and provider enrollment maintenance.