Credentialing and Enrollments Specialist

This is a fully remote position, open to applicants in Arizona, +4 more states.

📋 Description

• Prepare, submit, and oversee provider credentialing and payer enrollment applications for commercial, Medicare, Medicaid, and various health plans.

• Coordinate the initial credentialing process, recredentialing, and the maintenance of provider data for physicians and advanced practice providers.

• Ensure accurate maintenance of provider files, including CAQH profiles, NPI information, state licenses, DEA certificates, malpractice insurance, board certifications, and other necessary documentation.

• Manage credentialing, enrollment, and contracting records in CredentialStream and other specified databases.

• Monitor credentialing and enrollment statuses through payer portals and follow up to guarantee timely approvals.

• Track expiration dates for licenses, certifications, malpractice coverage, and other essential documents.

• Address payer requests for additional documentation or clarification.

• Provide status updates to leadership, billing managers, clinic managers, providers, and other relevant stakeholders.

• Assist in onboarding new providers, which includes managing credentialing timelines, payer enrollments, and hospital privileging requirements.

• Support the offboarding process for providers, including payer terminations and record updates.

• Maintain confidentiality and ensure adherence to HIPAA and organizational policies.

• Proactively identify and resolve any credentialing or enrollment delays.

• Keep thorough, accurate, and organized records while managing multiple provider enrollment timelines and deadlines.

⛳️ Requirements

• High school diploma or equivalent is required.

• A minimum of 2 years of experience in provider credentialing, payer enrollment, medical staff services, or healthcare administration is necessary.

• Working knowledge of CAQH, PECOS, NPPES, and payer enrollment portals is required.

• Experience in maintaining provider records and credentialing databases, including CredentialStream or similar credentialing software, is essential.

• Strong attention to detail and excellent organizational skills are a must.

• Exceptional written and verbal communication skills are required.

• Ability to prioritize tasks and effectively manage multiple deadlines is essential.

• Capability to work both independently and collaboratively in a remote setting.

• Proficiency in Microsoft Office Suite, EHR systems, practice management software, and online credentialing portals is necessary.

• Strong problem-solving abilities and follow-up skills are required.

• Experience with commercial and government payer enrollment processes is strongly preferred.

• Familiarity with hospital privileging and provider onboarding is preferred.

• Prior experience in allergy, asthma, or specialty medical practices is advantageous.

• Occasional overtime may be required.

• Physical ability to stand, walk, and move throughout the clinic for extended periods; occasionally lift objects up to 25 lbs., bend, stoop, or reach as necessary.

• Frequent use of hands and fingers for patient care and equipment operation is expected.

• Must possess normal (or corrected) vision and hearing and be able to respond promptly in a fast-paced clinical environment, if applicable.

🏝️ Benefits

• Medical insurance.

• Dental insurance.

• Vision insurance.

• 401(k) retirement plan with employer matching.

• Paid time off (PTO).

• Sick time.

• Floating holidays.

• Holiday pay.

• Competitive compensation.

• Professional development opportunities.

• Supportive, mission-focused culture.