Credentialing Enrollment Specialist

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

📋 Description

• Prepare, submit, and monitor provider enrollment applications with commercial, Medicaid, TRICARE, and other contracted health plans.

• Coordinate provider revalidations, reenrollments, and ongoing requirements for payer participation.

• Track application statuses and liaise with payer representatives to address delays and outstanding requests.

• Collaborate with Human Resources, Clinical Operations, Revenue Cycle, and Compliance to ensure providers are properly enrolled prior to service delivery.

• Maintain records of applications, approvals, correspondence, and payer confirmations.

• Investigate payer-specific enrollment requirements and communicate pertinent updates.

• Address inquiries related to enrollment status and provider network participation.

• Assist with the onboarding of clinic locations, provider additions, and organizational expansions that necessitate payer enrollment.

• Enhance enrollment workflows and contribute to the documentation of processes and standard operating procedures.

• Oversee payer enrollment schedules to support provider start dates and facilitate organizational growth.

• Resolve issues with application deficiencies, rejected enrollments, and requests for further documentation.

• Coordinate ongoing demographic and maintenance updates for approved providers.

⛳️ Requirements

• Outstanding organizational skills, meticulous attention to detail, and a strong commitment to accuracy.

• Capability to manage numerous provider enrollment, credentialing, and recredentialing applications while adhering to deadlines.

• Strong prioritization and time management abilities in a dynamic environment.

• Knowledge of provider enrollment, credentialing, and recredentialing requirements across various payers and states.

• Proficient in Microsoft Office Suite, CAQH, payer portals, and credentialing/enrollment database systems.

• Experience in preparing, submitting, tracking, and following up on provider enrollment and credentialing applications.

• Excellent verbal and written communication skills for effective interaction with providers, payers, and internal stakeholders.

• Ability to interpret and apply payer, regulatory, and accreditation requirements.

• Understanding of confidentiality requirements and capability to manage sensitive information discreetly.

• Ability to work autonomously as well as collaboratively with Credentialing, Revenue Cycle, Compliance, Human Resources, and Clinical Operations teams.

• High school diploma or equivalent is required.

• A minimum of two years of experience in provider enrollment, credentialing, healthcare administration, or a related healthcare support role.

• Experience with Medicaid, government, and commercial payer enrollment and credentialing applications.

• An Associate's or Bachelor's degree in Healthcare Administration, Business Administration, or a related field is preferred.

🏝️ Benefits

• Full-time employment.

• Fully remote work arrangement.