MODENA

Credentialing Specialist

• Prepare, submit, and manage provider credentialing and payer enrollment applications for commercial, Medicare, Medicaid, and other health plans
• Coordinate initial credentialing, recredentialing, and provider data maintenance for physicians and advanced practice providers
• Maintain accurate provider files, including CAQH profiles, NPI information, state licenses, DEA certificates, malpractice insurance, board certifications, and other required documentation
• Maintain credentialing, enrollment, and contracting records in CredentialStream and other designated databases
• Monitor credentialing and enrollment statuses through payer portals and follow up to ensure timely approvals
• Track expiration dates for licenses, certifications, malpractice coverage, and other required documents
• Respond to payer requests for additional documentation or clarification
• Communicate status updates to leadership, billing managers, clinic managers, providers, and other stakeholders
• Assist with onboarding new providers, including credentialing timelines, payer enrollments, and hospital privileging requirements
• Support provider offboarding, including payer terminations and record updates
• Maintain confidentiality and ensure compliance with HIPAA and organizational policies
• Proactively identify and resolve credentialing or enrollment delays
• Maintain complete, accurate, and organized records and manage multiple provider enrollment timelines and deadlines

Credentialing and Enrollments Specialist