Physician Enrollment & Credentialing Specialist

About the role

The Physician Enrollment & Credentialing Specialist ensures that providers are properly credentialed, enrolled, appointed, and privileged across commercial and government payers, hospitals, and other healthcare organizations to support uninterrupted patient care and timely reimbursement.

Key responsibilities

• Complete provider enrollment, credentialing, recredentialing, appointment, privileging and ongoing maintenance activities with payers and hospitals.
• Maintain accurate provider records in credentialing systems, payer portals, CAQH and other databases, ensuring compliance with NCQA, TJC, CMS and payer guidelines.
• Review denial queues, research and appeal claim denials, analyze trends and submit appeals within payer deadlines.
• Educate team members on payer updates, denial trends and process improvements.

Required profile

• Minimum two years of experience in provider credentialing and/or payer enrollment.
• Experience with hospital credentialing, medical billing, denial management and revenue cycle functions preferred.
• Strong analytical, organizational and problem‑solving abilities with a commitment to exceptional customer service.
• Ability to work independently while managing multiple priorities and meeting deadlines.

Required skills

• Proficiency in Microsoft Outlook, Word and Excel.
• Experience with payer portals and CAQH.
• Familiarity with EPIC Resolute Professional Billing (strongly preferred).

What we offer

• Competitive hourly compensation with benefits effective on hire.
• Company‑paid medical, dental and vision coverage (80‑85% of premiums).
• Life and AD&D insurance, optional additional coverage, PTO, holiday pay and 401k with company match.