Credentialing Specialist – Primary Care & Podiatry in Palm Springs, Florida at PBACO Holding LLC

We're a growing multispecialty practice (Primary Care & Podiatry) seeking an experienced Credentialing Specialist to own provider credentialing and payer enrollment from start to finish — from onboarding and application submission through payer follow-up, approval, roster maintenance, and recredentialing.

You'll work closely with Administration, Billing/Revenue Cycle, HR, and Compliance to ensure every provider is credentialed, enrolled, and linked to the correct locations and tax entities — so providers can see patients and claims get paid correctly and on time.

• Prepare, submit, and follow through on credentialing, recredentialing, and enrollment applications with Medicare (PECOS), Florida Medicaid, Medicare Advantage, Medicaid Managed Care, and commercial payers
• Maintain provider CAQH profiles, NPPES/NPI records, and payer portal information
• Coordinate the credentialing portion of new provider onboarding, starting payer enrollment as early as possible to minimize billing delays
• Track licenses, DEA certificates, malpractice coverage, board certifications, and expirations; perform primary-source verification and maintain audit-ready files
• Manage provider additions, terminations, demographic changes, and payer roster reconciliation
• Partner with Billing/Revenue Cycle to resolve credentialing-related claim denials (provider-not-enrolled, effective-date issues, incorrect group affiliation)
• Maintain a credentialing tracking system and provide regular status reports to leadership
• Identify new payer and network participation opportunities to expand patient access

• 2–3+ years of medical provider credentialing and payer enrollment experience
• Strong working knowledge of Medicare PECOS, NPPES/NPI, CAQH, and Florida Medicaid enrollment
• Familiarity with taxonomy codes, group/individual NPIs, TIN affiliations, reassignment, and payer effective dates
• Knowledge of NPDB, OIG/SAM exclusion screening, and licensure/DEA verification
• Experience with the South Florida/Palm Beach County payer market strongly preferred
• Multispecialty group, Primary Care, or Podiatry credentialing experience a plus
• AthenaOne/Athenahealth experience a plus
• Proficiency with Excel, Microsoft Office, payer portals, and credentialing databases

Extremely organized, detail-oriented, and persistent with payer follow-up. You manage multiple provider enrollments independently, catch credentialing problems before they become billing problems, and communicate clearly with payers, providers, and internal teams.

You won't just process applications — you'll own a function that directly impacts provider readiness and practice revenue, with visibility to leadership and room to build processes as we grow.