You are applying for a position through Medix, a staffing agency. The actual posting represents a position at one of our clients.

Job Summary

Our client is seeking a highly motivated Credentialing Specialist to join their team. In this role, you will be responsible for executing backlog demolition, auditing and locating missing files, performing primary source verification, and managing payer enrollment tasks to ensure timely and accurate provider credentialing.

Key Responsibilities

• Execute Backlog Demolition: Review, audit, and systematically resolve a 6,000-line item backlog of pending, stalled, or incomplete provider credentialing and enrollment tasks.
• Audit & Locate Missing Files: Investigate incomplete profiles, identify missing components, and execute the exact steps needed to push applications forward.
• Perform Primary Source Verification (PSV): Validate provider credentials including New Jersey State Licensure, DEA certificates, Controlled Styrax Registrations (CSR), and Board Certifications/eligibility.
• Manage Payer Enrollment Tasks: Review provider applications against specific insurance carrier guidelines to ensure zero-defect submissions to major payers (Horizon, UHC, Medicare).
• Rapid Onboarding Integration: Train 1-on-1 with an internal credentialing expert, capturing specific internal bylaws and routing workflows quickly to achieve independent production by week two.
• Data Integrity Maintenance: Update internal credentialing databases, tracking spreadsheets, and CAQH profiles to ensure real-time accuracy and compliance readiness.

Qualifications

• 2+ years of healthcare provider credentialing, medical staff services, or provider enrollment experience.
• Solid familiarity with Medicare (PECOS), UnitedHealthcare, and Horizon BCBS enrollment requirements.
• Working knowledge of essential provider credentials (Licensure, DEA, Board Certification).
• Proven capability to manage high-volume data cleanup or backlog environments without losing accuracy.
• Highly collaborative, an independent problem solver, and able to absorb technical training rapidly.
• Knowledge of credentialing software and associated applications (preferred).
• Certified Professional in Medical Staff Management (CPMSM) or Certified Provider Credentialing Specialist (CPCS) (preferred).
• Experience working directly for or closely with a major commercial health plan (Payer-Side experience) (preferred).
• Deep understanding of NCQA guidelines and New Jersey-specific payer enrollment portals (preferred).

Experience

• Minimum 2 years of experience in healthcare provider credentialing, medical staff services, or provider enrollment.
• Experience working directly for or closely with a major commercial health plan (Payer-Side experience) (preferred).

Skills

• Healthcare provider credentialing and enrollment.
• Primary Source Verification (PSV).
• Proficiency with Medicare (PECOS), UnitedHealthcare, and Horizon BCBS enrollment requirements.
• Knowledge of provider credentials including Licensure, DEA, and Board Certification.
• High-volume data cleanup and backlog management.
• Attention to detail and accuracy.
• Collaboration and independent problem-solving.
• Ability to rapidly absorb technical training.
• Familiarity with credentialing software (preferred).
• Understanding of NCQA guidelines (preferred).

Education

• Certified Professional in Medical Staff Management (CPMSM) or Certified Provider Credentialing Specialist (CPCS) (preferred).

Additional Requirements

• Shift: Monday-Friday, 8:00 AM - 4:30 PM (training for the first one to two weeks will be 7:30 AM - 4:00 PM).
• This is available as a contract role for 4-6 months or a contract-to-hire opportunity.

Benefits

• Paid Sick Leave (Medix provides paid sick leave according to state and local sick leave ordinances).
• Health Benefits / Dental / Vision (Medix offers 6 different health plans: 3 Major Medical Plans, 2 Fixed Indemnity Plans (Standard and Preferred), and 1 Minimum Essential Coverage (MEC) Plan. Eligibility for health benefits is based on verifying that an average of 30 hours per week during the first 4 weeks of the work assignment has been met. If you meet eligibility requirements and take action to enroll, you will be covered no earlier than 60 days into your assignment, depending on plan selection(s)).
• 401k (Eligible on the first 401k open enrollment date following 6 consecutive months on assignment. 401k Open Enrollment dates are 1/1, 4/1, 7/1, and 10/1).
• Short Term Disability Insurance.
• Term Life Insurance Plan.

Required Employment / Compliance Language

Medix is an equal opportunity employer and does not discriminate against any applicant or employee because of race, color, religion, sex, national origin, disability, age, or military status or any other protected class.

^*We will consider for employment all qualified Applicants, including those with criminal histories, in a manner consistent with the requirements of applicable federal, state, and local laws, including the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance (FCIHO), Los Angeles Fair Chance Ordinance for Employers (ULAC), The San Francisco Fair Chance Ordinance (FCO), and the California Fair Chance Act (CFCA).

Medix Overview:

With over 20 years of experience connecting organizations with highly qualified professionals, Medix is a leading provider of workforce solutions for clients and candidates across the healthcare, scientific, technology, and government industries. Through our core purpose of positively impacting lives, we’re dedicated to creating opportunities for job seekers at some of the nation's top companies. As an award-winning career partner, Medix is committed to helping talent find fulfilling and meaningful work because our mission is to help you achieve yours.

Any required state or Joint Commission training is compensated at the state or local minimum wage rate.

^*As a job position within our Revenue Cycle division, a successful completion of a background check may be required as a condition of employment. This requirement is directly related to essential job functions including but not limited to: accessing financial and confidential information, handling financial and other payment data, and working within departments that care for vulnerable populations, such as, minors, elderly and those with physical or mental disabilities. Due to these job duties, this position has a significant impact on the business operations and reputation, as well as the safety and well-being of individuals who may be cared for as part of the job position or who may interact with staff or clients.