Credentialing Associate

Job Description

REQUIREMENTS

• Minimum 1-3 years experience in credentialing and payor enrollment, including maintaining in-network contracts/enrollments with private and public payors.
• Knowledge of State Medicaid (including Managed Medicaid Care Organizations), Medicare, commercial/private health plans, and insurance carriers.
• Knowledge of PECOS system.
• Experience working with major payors like UnitedHealthcare, Aetna, Cigna, Blue Cross Blue Shield, etc.
• Strong attention to detail and accuracy.
• Excellent organizational and prioritization skills.
• Team-oriented with a collaborative mindset.
• Receptive to feedback and continuous improvement.

• Certification in payer enrollment, healthcare administration, or a related field is a plus (e.g., Certified Professional Coder – CPC or other relevant certifications).
• Experience working from home is preferred. Consistent access to a private work environment with high speed internet and professionally appropriate surroundings for frequent video conferencing and a workstation setup conducive to remote work needs.

RESPONSIBILITES

• Ensure all necessary documents (licenses, contracts, tax information, etc.) are submitted to payors and are current to meet enrollment and revalidation requirements.
• Act as the point of contact for resolving enrollment issues, such as rejections, delays, or discrepancies, by communicating directly with payors.
• Monitor and track revalidation deadlines for providers to ensure timely re-enrollment and prevent disruptions in reimbursement.
• Maintain records and provide reports on the status of payor enrollments, including completed, pending, and rejected applications.
• Ensure timely re-attestation of CAQH profiles.
• Regular and predictable attendance is required.
• All other duties as assigned.

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