Credentialing and Provider Enrollment Specialist

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

📋 Description

• Prepare, submit, and monitor Medicare enrollment applications via PECOS, encompassing individual, group, and benefit reassignment applications.

• Address development requests from the Medicare Administrative Contractor and rectify application discrepancies.

• Complete credentialing and contracting applications for Medicaid and commercial payers for both new and existing practice locations.

• Create, update, and re-attest CAQH ProView profiles using access granted by providers.

• Maintain records for NPI, licenses, DEA, board certifications, malpractice, and hospital privileges, noting expiration dates.

• Follow up with payers through phone, email, and online portals until applications are approved and effective dates are confirmed.

• Track application statuses, reference numbers, and effective dates in the practice's credentialing tracker.

• Inform the practice regarding approvals, denials, missing documents, and upcoming revalidation or re-credentialing deadlines.

• Process demographic updates such as new locations, address modifications, and additional services with each payer.

• Safeguard patient and provider information while adhering to HIPAA regulations.

⛳️ Requirements

• A minimum of 2 years of experience in U.S. healthcare credentialing and provider enrollment.

• Practical experience in submitting and managing Medicare applications through PECOS, including CMS-855 enrollment and reassignment.

• Familiarity with both commercial insurance and government health plans.

• Experience utilizing CAQH ProView, NPPES, and payer enrollment portals.

• Proficient in written and spoken English.

• Exceptional attention to detail and strong follow-up capabilities.

• Ability to work independently and manage multiple applications and deadlines effectively.

• Reliable internet connection and an appropriate remote workspace.

• Preferred experience credentialing surgeons or specialty practices such as orthopedics, spine, or pain management.

• Preferred experience enrolling a newly established group practice with multiple locations.

• Preferred familiarity with Georgia Medicaid and Georgia commercial insurance plans.

• Preferred experience with hospital and ambulatory surgery center privileging.

🏝️ Benefits

• Remote work arrangement.

• Part-time schedule.

• Availability during Eastern Time business hours is required.