Medical Insurance Credentialing Lead
Amazing Opportunity! Live & work near Disney with Medinex Healthcare Solutions! (Hybrid / Remote work)
* Must live in the Central Florida area *
Job Summary
The
Medical Insurance Credentialing Lead
will play a foundational role in designing, launching, and leading the organization’s new credentialing and payer enrollment function. This individual will serve as the subject-matter expert for all credentialing operations, responsible for building workflows, managing payer enrollments, ensuring compliance, and developing a scalable service offering.
In addition to performing hands-on credentialing work, this role will establish processes, tools, and quality standards and will hire and oversee a Credentialing Assistant as volume grows. The ideal candidate has deep credentialing expertise, enjoys building programs from the ground up, and is comfortable operating in both strategic and hands-on capacities.
Key Responsibilities
Program & Service Line Development
Design and implement the organization’s credentialing and re-credentialing program from the ground up
Develop credentialing workflows, tracking tools, turnaround standards, and standard operating procedures (SOPs)
Partner with leadership to support the launch of credentialing as a formal internal and external service offering
Establish scalable processes to support future growth, new practices, and expanded service demand
Credentialing & Enrollment Operations
Manage the full lifecycle of provider credentialing and re-credentialing for physicians and advanced practice providers
Prepare, submit, track, and follow up on enrollment applications with Medicare, Medicaid, and commercial payers
Maintain complete, accurate, and compliant provider credentialing files, including licenses, certifications, malpractice insurance, and payer documentation
Ensure timely updates and attestations in CAQH ProView, PECOS, NPPES, and payer-specific portals
Track credentialing timelines, expirations, and renewals to prevent billing delays or network participation gaps
Leadership & Oversight
Serve as the primary credentialing resource and escalation point for internal teams and external physician partners
Hire, train, and supervise a Credentialing Assistant as volume increases
Perform quality checks and internal audits to ensure adherence to payer requirements, NCQA standards, and regulatory guidelines
Create reporting and metrics related to credentialing turnaround times, payer approval rates, and revenue impact
Revenue Cycle & Compliance Collaboration
Work closely with billing and RCM teams to ensure credentialing status aligns seamlessly with claims workflows
Support new provider onboarding, practice start-ups, expansions, and network participation optimization
Monitor payer policy changes and Florida-specific regulatory updates, recommending and implementing process improvements
Contribute credentialing expertise to overall revenue optimization and compliance initiatives
Qualifications & Preferences
Required
4+ years of progressive medical insurance credentialing experience
Demonstrated success managing Medicare, Medicaid, and major commercial payer enrollments
Strong working knowledge of CAQH ProView, PECOS, NPPES, and payer enrollment platforms
Experience managing multiple providers and practices concurrently
Exceptional organizational skills and attention to detail
Strong written and verbal communication skills with payers, providers, and internal stakeholders
Ability to work independently and take ownership of building new operational functions
Preferred
Experience within an RCM, MSO, or multi-practice physician organization
Prior experience launching or formalizing credentialing workflows or programs
Bachelor’s degree in Healthcare Administration, Business, or related field
CPCS or CPMSM certification strongly preferred
Prior experience training or supervising credentialing staff
Knowledge of Florida healthcare and payer regulations
What We Offer
Competitive compensation with leadership and growth opportunity
Comprehensive benefits package including medical, dental, vision, 401(k) with company match, and paid time off
Flexible hybrid or remote work options
Professional development support, including certification reimbursement
Opportunity to build and lead a critical new service line from the ground up
Collaborative culture focused on accountability, quality, and continuous improvement
Join Us
If you are a credentialing professional who thrives in building programs, improving processes, and supporting physician success, we invite you to apply and help us launch our credentialing service.
