Credentialing and Payer Enrollment Specialist – Part-time

This is a fully remote position, open to applicants in Philippines.

📋 Description

• Prepare and submit initial enrollment applications for individual providers and group practices for both commercial and government plans.

• Complete, update, and attest CAQH ProView profiles while ensuring supporting documents are up-to-date.

• Maintain provider records in PECOS and NPPES, including handling revalidations, reassignments, and demographic updates.

• Monitor pending applications and engage with payer provider relations through phone, portal, and email until effective dates are confirmed.

• Oversee the recredentialing and revalidation calendar to avert provider lapses with payers.

• Gather and maintain credentialing documents such as state licenses, DEA registrations, malpractice insurance certificates, board certifications, W-9s, and CVs, keeping track of expiration dates.

• Submit updates on rosters, group additions and terminations, and demographic modifications to payers.

• Document every application, payer interaction, reference number, and effective date in the client’s credentialing tracker.

• Provide a weekly status report to the client contact and escalate any stalled or denied applications.

• Safeguard patient information while adhering to HIPAA regulations.

⛳️ Requirements

• Minimum of 2 years of experience in U.S. provider credentialing and payer enrollment.

• Practical experience with CAQH ProView, PECOS, and NPPES.

• Knowledge of commercial insurance and government health plans, including Medicare and Medicaid.

• Proficient in using payer portals and insurance websites.

• Comfortable making outbound calls to payer provider relations and network representatives.

• Strong proficiency in written and spoken English.

• Exceptional attention to detail and follow-up capabilities.

• Ability to work independently while managing multiple providers and applications simultaneously.

• Reliable internet connection and a suitable workspace for remote work.

• Experience with orthopedic or behavioral health provider enrollment is a plus.

• Familiarity with Texas commercial plans and Texas Medicaid is advantageous.

• Experience with state Medicaid enrollment portals in multiple states is preferred.

• Familiarity with AdvancedMD, Practice Fusion, or TherapyNotes is desirable.

• Must be available during U.S. Central Time business hours.

🏝️ Benefits

• Opportunity to transition to full-time as credentialing volume increases.

• Flexible remote work arrangement.

• Approximately 20 hours of work per week.

• Preference for applicants based in the Philippines.