Medical Credentialing Specialist at AMS Solutions

About AMS SolutionsAMS 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 OverviewWe 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 ResponsibilitiesManage initial credentialing and re-credentialing applications for physicians and mid-level providers across multiple U.S. statesComplete and maintain CAQH ProView profiles, ensuring all provider data is accurate, current, and attestation-readySubmit and track payer enrollment applications with commercial insurance companies, Medicare, and Medicaid programsMonitor credentialing timelines, follow up on pending applications, and escalate delays to ensure providers are enrolled before their start datesMaintain organized credentialing files including licenses, DEA certificates, malpractice insurance, board certifications, and other required documentationCoordinate with providers and practice managers to collect and verify required documentationTrack and manage license and certification expiration dates, initiating renewals proactivelyResearch and resolve payer enrollment issues, denials, and discrepanciesStay current on payer-specific enrollment requirements, state regulations, and CMS guidelinesPrepare and submit roster adds/changes for group enrollmentsGenerate regular status reports on credentialing activities and turnaround timesRequired Qualifications2-5 years of hands-on medical credentialing and payer enrollment experienceStrong working knowledge of CAQH ProView, PECOS, and NPPES/NPI systemsDemonstrated 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 proceduresProficiency in credentialing software and practice management systemsExcellent attention to detail and organizational skillsStrong written and verbal English communication skillsAbility to manage multiple provider files and deadlines simultaneouslyReliable internet connection and dedicated home office setup for remote workPreferred QualificationsExperience working with U.S.-based medical billing or RCM companiesKnowledge of provider contracting and fee schedule negotiation basicsCPCS (Certified Provider Credentialing Specialist) or CPMSM certificationExperience with EHR/PM systems such as eClinicalWorks, Athena, or AdvancedMDFamiliarity with hospital privileging processesThis position requires availability during U.S. business hours (Eastern or Central Time Zone). Specific schedule will be discussed during the interview process.

Medical Credentialing Specialist

Emma

Requirements and responsibilities

Skills wanted:

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About AMS Solutions:

www.amssolutions.com.au/

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