Payer Enrollment & Credentialing Specialist

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

📋 Description

• Prepare, finalize, and submit enrollment applications for providers to commercial insurance payers, Medicare, Medicaid, and various health plans.

• Oversee the payer enrollment application process from the initial submission through to approval and the effective date.

• Follow up with insurance companies concerning pending applications, missing documents, corrections, and enrollment statuses.

• Address requests from payers for additional information or documentation.

• Monitor submissions, reference numbers, effective dates, payer decisions, and outstanding requirements.

• Maintain payer enrollment records through demographic changes, practice location updates, provider additions, terminations, and other modifications.

• Identify any enrollment delays or issues and collaborate with payers and internal teams to resolve them.

• Ensure accurate maintenance of provider participation and payer enrollment records.

• Manage initial credentialing and re-credentialing processes.

• Collect, review, organize, and sustain provider credentialing documentation.

• Verify NPI, licenses, certifications, education, work history, malpractice coverage, and other credentials.

• Conduct audits of provider files for any missing, inaccurate, outdated, or expired documentation.

• Monitor expiration and renewal dates and follow up on necessary documentation.

• Prepare and submit credentialing and re-credentialing applications within specified timelines.

• Maintain comprehensive, audit-ready credentialing files.

• Resolve discrepancies in credentialing or incomplete applications.

• Maintain provider information across credentialing and payer systems, applications, payer portals, and internal records.

• Keep trackers for pending, completed, and outstanding applications.

• Document communications with payers and follow-up activities.

• Communicate with providers and internal stakeholders about documentation, application updates, and enrollment requirements.

• Escalate credentialing or enrollment issues as necessary.

⛳️ Requirements

• Practical experience with payer enrollment and provider credentialing is highly preferred.

• Proven experience in completing and submitting healthcare provider enrollment applications.

• Knowledge of commercial payers, Medicare, and/or Medicaid enrollment processes.

• Experience in managing credentialing or enrollment applications from submission to approval.

• Familiarity with provider credentialing documentation, including NPI, professional licenses, certifications, malpractice insurance, and other provider records.

• Experience with initial credentialing and re-credentialing workflows.

• Proven ability to communicate and follow up directly with insurance payers regarding application statuses and outstanding requirements.

• Familiarity with credentialing platforms, payer portals, and provider databases is highly desirable.

• Experience in maintaining credentialing/enrollment trackers and managing multiple deadlines simultaneously.

• Prior experience in healthcare administration or as a Medical VA is preferred.

• Strong understanding of provider credentialing and payer enrollment processes.

• Highly organized and detail-oriented, with excellent documentation and tracking abilities.

• Capable of independently following up on pending applications without constant supervision.

• Strong problem-solving skills for addressing payer delays, missing documentation, or application discrepancies.

• Exceptional written and verbal communication skills in English.

• Comfortable communicating professionally with insurance representatives, providers, and internal teams.

• Ability to manage multiple providers, payers, applications, and deadlines simultaneously.

• Commitment to accuracy, confidentiality, and HIPAA compliance.

• Must demonstrate clear and professional English writing and speaking skills.

• Relevant work experience is required.

• Must provide an NBI Clearance and/or Local Police Clearance prior to onboarding.

• Must attend video meetings with the camera on when necessary.

• A reliable laptop or desktop computer is required.

• A stable high-speed internet connection of at least 25 Mbps is necessary.

• A noise-canceling headset is required.

• A working webcam is needed.

• A quiet and professional work environment is essential.

🏝️ Benefits

• Dedicated HR & Contractor Support Team: Gain access to world-class assistance for inquiries, guidance, contract matters, and client communication.

• Premium VPN Access (Optional): A secure VPN license can be requested to enhance privacy and security for client-related tasks.

• HIPAA & Cybersecurity Training + Certification (Provided): Access to internal HIPAA compliance training, cybersecurity modules, and certification.

• Top 1% VA Performance Training: Proprietary training covering communication, client management, productivity systems, and best practices.

• Client-Approved U.S. Holidays: Contractors can take U.S. holidays off based on client needs and schedules.

• Client-Approved Paid or Unpaid Time Off: Time off may be granted by the client; paid time off is optional and only if offered by the client.

• Access to Tools & Resources: Templates, workflow guides, productivity tools, and client-specific SOP support.

• Optional Performance-Based Incentives: Some clients may provide bonuses, incentives, or increased hours based on performance.

• Independent contractor perks and client-approved allowances.