Credentialing Specialist – US Healthcare

About the role

Revex Square is seeking an experienced Credentialing Specialist to manage U.S. healthcare provider credentialing, enrollment, recredentialing, and payer follow‑up. The role requires independent handling of cases from initial application through approval.

Key responsibilities

• Manage complete provider and group credentialing/enrollment processes, including CAQH profiles, NPI/NPPES, PECOS, Medicare and Medicaid enrollment.
• Submit applications to commercial and government payers, track status, handle provider additions, terminations, demographic updates, and practice‑location changes.
• Conduct recredentialing, revalidation, EFT/ERA enrollment, and payer portal registrations.
• Aggressively follow up with insurance companies, resolve deficiencies, and maintain organized credentialing trackers and documentation.

Required profile

• 1+ years of hands‑on U.S. healthcare credentialing experience.
• Strong understanding of CAQH, PECOS, NPPES, Medicare, Medicaid and major commercial payers.
• Excellent written and verbal English communication with strong attention to detail.
• Ability to manage multiple providers and credentialing cases simultaneously.

Required skills

• CAQH credentialing platform
• PECOS enrollment system
• NPPES/NPI management
• Medicare and Medicaid enrollment processes
• Commercial payer enrollment and follow‑up