Credentialing Enrollment Specialist

Accountabilities: Review provider credentialing applications for accuracy, completeness, and compliance with mandatory health plan accreditation requirements before preparing files for Corporate Credentialing Committee review. Contact healthcare providers and their designated representatives to obtain missing information, clarify application details, and update expired Council for Affordable Quality Healthcare (CAQH) applications. Conduct primary source verifications, including professional licenses, board certifications, Medicare and Medicaid sanctions through the Office of Inspector General (OIG), National Practitioner Data Bank records, professional liability coverage, and accreditation status. Respond promptly and professionally to incoming phone calls, emails, and written correspondence from providers and their representatives regarding credentialing applications and requirements. Educate providers and their designees on credentialing procedures, documentation requirements, and applicable standards, ensuring that questions are addressed accurately and in a timely manner. Add providers to the CAQH roster before their 36-month recredentialing deadlines. Enter and maintain accurate provider information in credentialing systems and coordinate enrollment processing with operational teams to complete network participation. Monitor, document, and assign incoming paper credentialing applications to ensure appropriate processing and follow-up. Serve as a resource for Provider Network Services, Reimbursement Records, and internal teams that rely on provider records and credentialing information. Interpret and apply relevant credentialing regulations, accreditation standards, and corporate and federal compliance requirements throughout the credentialing process. Maintain confidentiality when handling sensitive provider documents and records, following established privacy and compliance procedures. Requirements: High school diploma or equivalent required; additional education in communications, human relations, or medical terminology is beneficial. One year of operational experience within a health insurance organization, particularly in customer service, claims, or membership functions, is strongly preferred. Alternatively, two years of demonstrated experience working with medical insurance or provider licensing is strongly preferred. Strong computer skills and the ability to work effectively with internal systems, credentialing platforms, and standard business applications. Excellent verbal and written communication skills, with the ability to interact professionally and positively with healthcare providers, representatives, and internal stakeholders. Strong attention to detail and the ability to prepare, review, and manage confidential documentation accurately. Good organizational and multitasking skills, including the ability to switch between varied tasks while meeting deadlines. Ability to work independently, exercise sound judgment, and determine appropriate approaches to resolving problems. Ability to remain effective under pressure while managing competing priorities and time-sensitive credentialing activities. Commitment to maintaining confidentiality and complying with corporate compliance policies and applicable accreditation requirements. Willingness and ability to complete annual education and training on applicable health plan accreditation standards. Must reside in Kansas or Missouri, or be willing to relocate as a condition of employment. Benefits: Estimated hourly compensation range of $23.58–$29.48, depending on skills, education, experience, and training. Eligibility for an incentive pay program (EPIP). Health, vision, and dental insurance. Six weeks of paid parental leave for new mothers and fathers. Fertility and adoption assistance. Two weeks of paid caregiver leave. 401(k) plan with employer matching contributions of up to 5%. Tuition reimbursement. Health and fitness benefits, discounts, and wellness resources. Paid vacation and sick leave, available immediately upon hire. Hybrid or onsite work arrangement, with potential work-from-home flexibility when performance and deadlines are consistently met. Opportunities for ongoing professional training and career development. Flexible work environment and a culture focused on family support, collaboration, and inclusion.