Credentialing Specialist/Front Desk Support

Medical Credentialing Specialist
Credentialing / Provider Services
Reports To: CEO
Employment Type: Full-Time
Location: Remote

Position Summary
We are seeking an experienced Senior Medical Credentialing Specialist to own and lead the credentialing function for our practice with minimal day-to-day supervision. This person will manage the full credentialing and payer enrollment lifecycle for all providers, partner closely with the billing team to keep providers compliant and in-network, and serve as the subject-matter expert the rest of the team relies on.
In addition to leading credentialing, this role supports our front desk operations. The specialist will answer phones and schedule patient appointments when calls roll over from the front desk, and will step in to support other front-desk functions as needed. The ideal candidate is highly organized, self-directed, and comfortable balancing detailed compliance work with patient-facing support.
Key Responsibilities
Credentialing & Provider Enrollment (Primary)
• Take charge of the practice's credentialing operations independently, managing the complete lifecycle for all providers from initial credentialing through re-credentialing.
• Complete and submit initial credentialing, re-credentialing, and payer enrollment applications for commercial and government payers (Medicare, Medicaid, and managed care plans).
• Maintain and update provider profiles in CAQH ProView, PECOS, NPPES/NPI, and payer portals, ensuring all information is accurate and current.
• Perform primary source verification of licenses, education, training, board certifications, work history, and malpractice coverage.
• Track and proactively manage expirables — state licenses, DEA registrations, board certifications, malpractice insurance, and other time-sensitive credentials — and renew them ahead of deadlines to prevent lapses.
• Maintain organized, audit-ready provider files and credentialing records in compliance with applicable standards (e.g., NCQA, Joint Commission, CMS, and payer requirements).
• Monitor application status, follow up persistently with payers, and resolve issues to keep enrollment moving and minimize delays.
• Serve as the internal point of contact and resource on credentialing questions, escalations, and process improvements.


Billing & Compliance Collaboration
• Work closely with the billing team to ensure providers remain in compliance with all credentialing and enrollment requirements so that claims can be submitted and reimbursed without disruption.
• Communicate provider effective dates, network participation status, and enrollment changes to billing in a timely manner.
• Help research and resolve claim denials or holds tied to credentialing or enrollment issues.
• Keep leadership and billing informed of upcoming renewals, compliance risks, and any gaps that could affect reimbursement.
Front Desk & Patient Support (Secondary)
• Answer incoming phone calls that roll over from the front desk, providing courteous and professional service to patients.
• Schedule, reschedule, and confirm patient appointments accurately.
• Support additional front-desk functions as needed, such as patient check-in/check-out, verifying demographic and insurance information, and responding to general patient inquiries.
• Provide coverage and backup for front-desk staff during high-volume periods, breaks, or absences.
Required Qualifications
• 3+ years of hands-on medical credentialing and/or payer enrollment experience.
• Demonstrated ability to manage credentialing operations independently with minimal supervision.
• Working knowledge of credentialing standards and regulatory requirements (NCQA, CMS, Joint Commission, and payer-specific guidelines).
• Proficiency with CAQH, PECOS, NPPES, and commercial/government payer enrollment portals.
• Strong understanding of how credentialing and enrollment affect billing and reimbursement.
• Excellent organizational skills and attention to detail, with the ability to track many deadlines simultaneously.
• Professional verbal and written communication skills and a patient-friendly phone manner.
• Comfortable using practice management and/or credentialing software, EHR systems, and standard office applications.
• High level of discretion and the ability to handle confidential provider and patient information in compliance with HIPAA.
Preferred Qualifications
• CPCS (Certified Provider Credentialing Specialist) or CPMSM (Certified Professional Medical Services Management) certification through NAMSS or equivalent experience.
• Prior experience in a lead or senior credentialing role.
• Front desk, scheduling, or patient-facing healthcare experience.
• Familiarity with the specialties and payers relevant to our practice.
Core Competencies
• Ownership & autonomy — takes initiative and drives the credentialing function forward without needing close oversight.
• Detail & accuracy — treats deadlines and documentation as non-negotiable.
• Collaboration — works seamlessly across credentialing, billing, and front-desk teams.
• Adaptability — moves comfortably between focused compliance work and patient-facing support.
• Customer service — represents the practice professionally to patients and payers alike.
Work Environment & Physical Requirements
• Standard medical office environment.
• Extended periods of computer and phone work.
• Occasional reaching, lifting of office materials, and movement throughout the office to support front-desk coverage.
This job description is intended to convey information essential to understanding the scope of the position. It is not an exhaustive list of responsibilities, skills, or working conditions, and may be adjusted as the needs of the practice evolve.

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This job description is intended to convey information essential to understanding the scope
of the position. It is not an exhaustive list of responsibilities, skills, or working conditions,
and may be adjusted as the needs of the practice evolve.

.