Medical Credentialing Specialist

Job Description

Job Description

Job Title: Credentialing Specialist

Location: Ahwatukee, AZ

Hours & Schedule: Part-Time, 20–25 hours per week

Work Environment: In Person - Admin Office

Salary / Hourly Rate: $24–$26 DOE

Benefits Offered: Medical, Dental, Vision, Paid Time Off, 401(k)

Why work with us:

We are dedicated to excellence in patient care and operational integrity. Our team values collaboration, continuous improvement, and accountability. Joining us means becoming part of a supportive environment that fosters professional growth while making a meaningful impact on our patients and providers.

What our ideal new team member looks like:

You are detail-oriented, organized, and thrive in a fast-paced healthcare environment. You take pride in accuracy, compliance, and clear communication. You enjoy managing multiple priorities and are passionate about ensuring that every credentialing process is thorough, timely, and compliant.

Job Summary:

The Credentialing Specialist supports the Billing and Finance Department by managing all aspects of provider credentialing, payer enrollment, and re-credentialing. This position ensures that all physicians, nurse practitioners, and physician assistants are accurately credentialed and actively enrolled with contracted insurance plans to maintain uninterrupted reimbursement and compliance.

Job Duties & Responsibilities:

• Prepare and submit initial credentialing, re-credentialing, and payer enrollment applications for all providers and practice locations.
• Maintain accurate and current provider records, including licenses, DEA, NPI, board certifications, malpractice insurance, and CAQH profiles.
• Track expirations, renewals, and re-attestation deadlines to ensure compliance with payer and regulatory requirements.
• Conduct primary source verification and maintain complete digital credentialing files.
• Communicate directly with payers, providers, and internal departments to resolve application or enrollment issues.
• Coordinate with HR during provider onboarding and terminations to ensure timely credentialing actions.
• Collaborate closely with billing and revenue cycle teams to confirm provider enrollment aligns with payer rosters and reimbursement rules.
• Prepare regular status reports and updates for leadership regarding pending applications, revalidations, and upcoming expirations.
• Support audits, compliance checks, and payer correspondence as needed.
• Stay updated on changes in managed care regulations and medical terminology to ensure best practices are followed.

Prerequisites / License & Certification Requirements:

• High school diploma or equivalent required; Associate’s or Bachelor’s degree preferred
• Minimum of 2 years of credentialing and/or payer enrollment experience in a healthcare or medical practice environment
• Knowledge of insurance payer processes, NCQA standards and accreditation processes, CAQH, NPPES/PECOS, and credentialing software systems
• Familiarity with CMS, commercial insurance, and Medicaid enrollment processes preferred
• Proficiency in Microsoft Office (Word, Excel, Outlook)
• Strong attention to detail, accuracy, and organizational skills
• Professional written and verbal communication abilities
• Ability to work independently and maintain confidentiality

If you meet all of our criteria and would like to be considered, please apply with your most updated resume or CV. Cover letter and references are preferred but optional. We look forward to meeting you!

#T1