Job Description

Job Location WoundCentrics Corporate Office - New Braunfels, TX 78130 Education Level 2 Year Degree

We are a dynamic and growing medical group dedicated to delivering high-quality patient care through excellence in operations and compliance. We are seeking a skilled Payer Credentialing Specialist to join our team. This role focuses exclusively on payer enrollment and contract maintenance for our physicians and advanced practice providers.

The Payer Credentialing Specialist will oversee all aspects of provider enrollment, payer applications, and maintenance across commercial and government insurance plans. The ideal candidate has a deep understanding of payer credentialing workflows, insurance plan requirements, and timeline management, ensuring seamless participation and timely reimbursement for our providers.

Key Responsibilities:

• Manage end-to-end payer enrollment and recredentialing for all providers within the medical group.
• Prepare, submit, and track applications with commercial and government payers (Medicare, Medicaid, BCBS, Aetna, Cigna, UnitedHealthcare, etc.)
• Maintain accurate provider records in CAQH, NPPES, PECOS, Availity, and other payer portals.
• Coordinate with internal teams to ensure alignment between credentialing, contracting, and billing operations.
• Track and manage effective dates, payer IDs, and credentialing expirables to prevent lapses in participation.
• Resolve payer-related credentialing issues and follow up to ensure timely approvals.
• Maintain compliance with payer-specific requirements and state/federal regulations
• Assist in payer audits and compliance reviews related to credentialing.

Qualifications

Qualifications:

• Minimum 5 years of payer credentialing experience in a medical group, MSO, or healthcare organization.
• Deep understanding of payer enrollment processes and credentialing best practices.
• Experience with CAQH, PECOS, and payer portals (e.g., Availity).
• Familiarity with HIPAA and CMS regulations
• Strong attention to detail, organization, and follow-up.
• Excellent written and verbal communication skills.
• CPCS or CPMSM certification preferred.

Why Join Us:

• Competitive salary and benefits package
• Flexible work environment (remote/hybrid options available)
• Collaborative and supportive team culture
• Opportunity to work in a compliance-driven, growth-oriented organization