Credentialing Specialist Lead

Key Responsibilities

• Manage the full credentialing lifecycle for physicians, NPs, and PAs — including Medicaid, Medicare, and commercial payer enrollments (Empire BCBS, Fidelis, Aetna, etc.).
• Review and verify provider documents such as medical licenses, DEA, board certifications, malpractice coverage, and CVs.
• Prepare, track, and submit enrollment applications accurately and within payer timelines.
• Monitor revalidation and re-credentialing schedules to ensure ongoing compliance.
• Serve as the primary point of contact for escalated payer or provider inquiries.
• Partner with internal billing and operations teams to ensure credentialing aligns with billing readiness.
• Maintain credentialing logs, dashboards, and internal trackers for reporting purposes.
• Assist in training and supporting new credentialing specialists, ensuring quality and consistency across workflows.

Qualifications

• 3+ years of healthcare credentialing experience; dermatology or multispecialty experience preferred.
• Strong knowledge of CAQH, NPPES, Medicaid, Medicare, and commercial payer portals.
• Exceptional attention to detail, organization, and follow-through.
• Excellent communication and interpersonal skills.
• Proficiency in Excel and credentialing systems; experience with eClinicalWorks a plus.