[Hiring] Credentialing Specialist @Nimble Solutions

Role Description

The Credentialing Specialist supports the provider credentialing and payer enrollment functions for multiple healthcare clients within the RCM organization. This role ensures that all providers are accurately credentialed and enrolled with Medicare, Medicaid, and commercial health plans to prevent claim denials and optimize reimbursement. The specialist serves as the main point of contact between providers, payers, and internal teams to maintain compliance and credentialing accuracy.

Responsibilities

• Manage end-to-end credentialing and recredentialing for providers across assigned client accounts.
• Prepare, submit, and track payer enrollment and participation applications for Medicare, Medicaid, and commercial health plans.
• Verify provider credentials, including licenses, NPI, DEA, malpractice, CAQH profiles, and board certifications.
• Maintain detailed, organized records of all credentialing activities within internal databases and client systems.
• Communicate with providers, payers, and internal teams to resolve credentialing issues or delays.
• Proactively monitor upcoming expirations and initiate timely renewals to ensure continuous network participation.
• Collaborate with the contracting and billing teams to align provider enrollment with payer contracts and claim submission readiness.
• Stay current with payer policies, CMS, and NCQA credentialing standards to ensure compliance.
• Generate credentialing status reports and provide updates to internal leadership and client contacts.

Qualifications

• Associate’s or Bachelor’s degree preferred (Healthcare Administration or related field).
• Minimum 2 years of credentialing or provider enrollment experience, preferably with an RCM vendor or multi-client environment.
• Familiarity with Medicare/Medicaid enrollment processes, PECOS, CAQH, and payer portals.
• Strong organizational and documentation skills with attention to detail.
• Excellent written and verbal communication.
• Ability to manage multiple client accounts and deadlines simultaneously.
• Proficient in Microsoft Office and credentialing/enrollment software.
• CPCS (Certified Provider Credentialing Specialist) or CPMSM (Certified Professional Medical Services Management) preferred but not required.

Work Environment

• Fast-paced, deadline-driven RCM vendor environment.
• Remote work setting with cross-functional collaboration across clients, operations, and payer teams.
• Must maintain confidentiality of provider and client data at all times.