Managed Care

Managed Care & Medical Staff Credentialing Specialist Position Summary At Wilson Health, we believe exceptional patient care depends on a strong foundation of quality, safety, and compliance. As our Managed Care & Medical Staff Credentialing Specialist, you will play a critical role in ensuring every provider who cares for our patients is properly credentialed, enrolled, and ready to deliver high-quality care. In this role, you'll work closely with clinical leadership, medical staff services, revenue cycle, and external payers to manage all aspects of provider credentialing and payer enrollment. You'll support the accuracy, integrity, and timeliness of provider onboarding, ensuring our physicians and advanced practice providers can practice without interruption and that Wilson Health remains compliant with accreditation and regulatory requirements. Through your work, you will strengthen operational efficiency, support timely revenue capture, and help uphold the high standards our community expects from Wilson Health. Key Perks and Benefits • Access to Employer Direct Care Clinic—free medical care and pharmacy services for eligible employees and covered dependents. • Free onsite employee fitness center. • Generous paid time off program beginning day one. • Medical, Dental, and Vision Insurance—multiple plan options with coverage beginning day one. • Health Savings Account (HSA) with employer contribution and Flexible Spending Accounts (FSA) for medical and dependent care. • Company-paid Life Insurance and Long-Term Disability; Salary Continuation beginning day one. • Voluntary Accident, Critical Illness, and supplemental Life/AD&D coverage. • Industry-leading retirement plan with employer contributions beginning day one. • Tuition Assistance Program. • Discounted Child Care Program. Employment Status: Full-Time, Hybrid Remote Working Hours: 40 hours/week (Salaried) Shift: 1st Shift Reports To: Chief Medical Officer Key Responsibilities Provider Enrollment & Payer Management • Complete provider enrollment applications, revalidations, and roster updates for all payer types. • Maintain CAQH, NPPES, PECOS, and payer portal profiles. • Track application status and communicate updates to revenue cycle and operational leaders. • Resolve payer enrollment issues proactively to avoid reimbursement delays. Medical Staff Credentialing • Manage initial credentialing and recredentialing processes for all providers. • Conduct primary source verification for licensure, education, certification, and malpractice coverage. • Prepare credentialing packets for committee review and maintain accurate documentation. • Monitor expirables and maintain compliant credentialing files. Compliance & Record Management • Maintain databases, logs, and reporting tools related to credentialing and enrollment. • Ensure compliance with ACHC, CMS, state regulations, and Medical Staff Bylaws. • Protect confidentiality and maintain secure credentialing records. Cross-Functional Collaboration • Partner with providers, recruitment, revenue cycle, and practice operations. • Serve as a resource for internal departments regarding credentialing requirements and timelines. • Support smooth onboarding and timely provider readiness. Qualifications Required • High school diploma or equivalent. • Minimum 2 years of medical staff credentialing or payer enrollment experience. • Proficiency with CAQH, NPPES, PECOS, and payer portals. • Strong organizational skills and ability to manage multiple priorities. • High attention to detail and accuracy. • Ability to maintain confidentiality with sensitive information. Preferred • Associate's or Bachelor's degree in Healthcare Administration, Business, or related field. • Experience with ACHC or similar accreditation standards. • Familiarity with medical terminology and hospital or medical group operations. Core Competencies • Strong communication and interpersonal skills. • High attention to detail and accuracy. • Customer service mindset when supporting providers and internal partners. • Ability to interpret regulations and payer requirements. • Effective problem-solving and follow-through. • Commitment to quality and patient-centered values.