HelpSquad

Insurance

• Manage the full credentialing lifecycle, including initial payer enrollment, contracting, recredentialing, revalidation, and ongoing payer participation across multiple payers and states
• Prepare, submit, and track applications from initial submission through approval and confirmed effective date
• Build and maintain CAQH ProView profiles, including initial setup, attestations, and reattestations
• Ensure provider information is accurate and consistent across CAQH, payer portals, and internal records
• Maintain complete and current provider files, including NPI Type 1 and Type 2, taxonomy codes, state licenses, DEA registrations, board certifications, malpractice insurance, and provider demographics and practice information
• Submit and manage Medicare enrollment through PECOS
• Complete enrollment with state Medicaid programs and managed-care plans, as well as commercial and behavioral health payers
• Monitor pending, incomplete, returned, and rejected applications and follow up proactively through payer portals and provider-enrollment phone lines
• Resolve enrollment issues and follow applications through to an approved effective date
• Maintain a centralized credentialing tracker and provide weekly status reports
• Monitor upcoming recredentialing, revalidation, license, certification, and other expiration deadlines to prevent lapses
• Escalate payer delays or issues when necessary
• Coordinate with billing to confirm payer enrollment and effective dates so claims are not submitted before a provider is properly active
• Maintain accurate, organized, and audit-ready credentialing documentation

Insurance Credentialing Specialist