Description
The Credentialing & Enrollment Representative evaluates, analyzes, and coordinates credentialing and recredentialing for medical, dental, optometry, and behavior-health providers and clinics with participating health insurance plans. The role handles health-plan enrollment applications, CAQH and NPPES data, provider and clinic records, verifications, compliance reviews, reporting, and communication with providers, health plans, and internal stakeholders. It requires at least two years of full-time credentialing experience, knowledge of Medicare, Medicaid, managed care, and commercial plans, strong Excel and Microsoft Office skills, and a bachelor’s degree in a related field is preferred.
