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. This position is for 1 individual. AMS is not seeking assistance from a group or other entity.

Originally posted on Himalayas