Job Description

Position Summary / Scope of Responsibility MedVanta is the nation's largest physician-owned and operated next-generation management services organization (MSO). Specializing in musculoskeletal (MSK) care, our services go beyond those of a traditional MSO by equipping our clients with the data, infrastructure, technology, and administrative support necessary to thrive. MedVanta fosters an employee-centered, inclusive culture that promotes growth, diversity, and teamwork. We empower our employees through collaborative leadership, cross-functional learning, and a shared commitment to excellence. The Credentialing Specialist supports the enrollment and credentialing process for medical providers by performing administrative, technical, and verification functions to ensure accuracy, compliance, and timely processing. This role works closely with the Credentialing Manager, providers, payors, and internal departments to maintain credentialing standards and operational efficiency. Primary Responsibilities The incumbent may be asked to perform job-related tasks other than those specifically stated in this description. The duties and responsibilities of the position are to be carried out in a manner that is consistent with the Mission, Core Values and Operating Principles of MedVanta. Review and process initial and recredentialing applications for providers in accordance with MedVanta, federal, and state requirements. Submit and manage enrollment applications with Medicare (PECOS), Medicaid portals (e.g., EPREP), CAQH, Availity, and other payor-specific platforms. Conduct primary source verification for education, licensure, board certification, malpractice, and work history per NCQA, URAC, and regulatory standards. Identify and resolve inconsistencies or gaps in credentialing documentation and escalate issues to the Credentialing Manager when necessary. Maintain accurate provider data across credentialing databases, including EHR systems and credentialing platforms. Ensure proper use of tools such as Modio Health, CAQH, PECOS, and internal spreadsheets for tracking provider status. Communicate directly with providers, internal departments, and health plans to gather required documents or respond to inquiries. Submit provider rosters and maintain records for delegated credentialing agreements. Work collaboratively within a remote or in-office team environment. Contribute to process improvements and uphold best practices in credentialing operations. Track credentialing deadlines, monitor expirables, and ensure timely renewals. Prepare regular status reports and documentation audits for management and regulatory agencies as needed. Assist in file audits and respond to requests for credentialing data from internal stakeholders. Perform additional tasks or projects as assigned by the Credentialing Manager. Performs other duties as assigned. Required Education and Experience High School Diploma or GED required; Associate's or Bachelor's Degree preferred. Minimum 3 years of professional experience in healthcare credentialing and/or provider enrollment. At least 2 years of direct experience with Medicare (PECOS), Medicaid (e.g., EPREP), CAQH, and commercial payor enrollment systems. Strong experience with credentialing software and EHR systems; knowledge of Modio is a plus. Proficient in Microsoft Excel, Outlook, and Word. Actively pursuing or holds CPCS (Certified Provider Credentialing Specialist) certification preferred. Competencies / Required Skills and Abilities Strong understanding of primary source verification standards and payer enrollment processes. Ability to manage multiple tasks and meet deadlines in a high-volume, fast-paced environment. Excellent written and verbal communication skills. High attention to detail with critical thinking and problem-solving abilities. Ability to work independently with minimal supervision, as well as part of a collaborative team. Professional demeanor with strong organizational and time management skills. Comfortable working with confidential and sensitive information. Physical Demands Must be able to sit for long periods of time and lift up to 25 pounds. Must be able to use appropriate body mechanics techniques when performing desk duties. Requires frequent bending, reaching, repetitive hand movements, standing, walking, squatting, and sitting. Adequate hearing to perform duties in person and over telephone. Must be able to communicate clearly to patients in person and over the telephone. Visual acuity adequate to perform job duties, including reading materials from printed sources and computer screens. Equal Opportunity Employer This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor. MedVanta

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