Credentialing Specialist

• Own the end-to-end payer enrollment process for new and existing providers, including initial enrollments, revalidations, demographic updates, terminations, and maintenance across commercial, Medicare, and Medicaid health plans
• Submit, track, and proactively follow up on payer enrollment applications
• Serve as the primary point of contact with health plans, delegated credentialing organizations, CVOs, and internal stakeholders to resolve enrollment issues and escalations
• Maintain accurate provider data across payer portals, CAQH, credentialing systems, and internal tracking tools
• Support delegated credentialing activities, provider rosters, compliance monitoring, and audit documentation
• Conduct routine audits of provider enrollment and credentialing files for NCQA, CMS, state, and payer-specific compliance
• Monitor enrollment and credentialing metrics, identify risks, and communicate status updates to leadership and cross-functional partners
• Collaborate with Licensing, Practice Operations, Revenue Cycle, Recruiting, and Clinical Operations teams
• Improve enrollment and credentialing workflows through standardization, documentation, automation, and operational efficiencies
• Support new state license applications, renewals, cross-licensure efforts, and licensure record maintenance
• Monitor provider licenses, DEA and CDS registrations, board certifications, malpractice coverage, and other required credentials
• Support providers throughout enrollment, credentialing, and licensing by communicating requirements, timelines, and next steps

Credentialing Specialist jobs in Arizona

Licensing and Credentialing Specialist