Medical Credentialing Specialist

About AMS Solutions

AMS Solutions is a leading medical billing and revenue cycle management company serving healthcare practices across the United States. We specialize in helping physicians maximize their revenue through expert billing, coding, credentialing, and practice management services. Our team is growing and we're looking for talented professionals to join us.

Position Overview

We are seeking an experienced Medical Credentialing Specialist to help support our team with the end-to-end credentialing and re-credentialing process for healthcare providers across multiple U.S. states. This role is critical to ensuring our clients' providers are properly enrolled with insurance payers, enabling timely and accurate reimbursement. The ideal candidate has strong CAQH management experience and a proven track record in multi-state payer enrollment.

Key Responsibilities

Manage initial credentialing and re-credentialing applications for physicians and mid-level providers across multiple U.S. states
Complete and maintain CAQH ProView profiles, ensuring all provider data is accurate, current, and attestation-ready
Submit and track payer enrollment applications with commercial insurance companies, Medicare, and Medicaid programs
Monitor credentialing timelines, follow up on pending applications, and escalate delays to ensure providers are enrolled before their start dates
Maintain organized credentialing files including licenses, DEA certificates, malpractice insurance, board certifications, and other required documentation
Coordinate with providers and practice managers to collect and verify required documentation
Track and manage license and certification expiration dates, initiating renewals proactively
Research and resolve payer enrollment issues, denials, and discrepancies
Stay current on payer-specific enrollment requirements, state regulations, and CMS guidelines
Prepare and submit roster adds/changes for group enrollments
Generate regular status reports on credentialing activities and turnaround times

Required Qualifications

2-5 years of hands-on medical credentialing and payer enrollment experience
Strong working knowledge of CAQH ProView, PECOS, and NPPES/NPI systems
Demonstrated experience with multi-state credentialing (enrollment across 3+ U.S. states)
Familiarity with commercial payer enrollment processes (UnitedHealthcare, Aetna, Cigna, Blue Cross Blue Shield, Humana, etc.)
Experience with Medicare and Medicaid enrollment procedures
Proficiency in credentialing software and practice management systems
Excellent attention to detail and organizational skills
Strong written and verbal English communication skills
Ability to manage multiple provider files and deadlines simultaneously
Reliable internet connection and dedicated home office setup for remote work

Preferred Qualifications

Experience working with U.S.-based medical billing or RCM companies

Knowledge of provider contracting and fee schedule negotiation basics

CPCS (Certified Provider Credentialing Specialist) or CPMSM certification

Experience with EHR/PM systems such as eClinicalWorks, Athena, or AdvancedMD

Familiarity with hospital privileging processes

This position requires availability during U.S. business hours (Eastern or Central Time Zone). Specific schedule will be discussed during the interview process.