Credentialing & Payor Enrollment Specialist
New
Based in the United StatesFull-TimeMiddle
Salary19.75 - 23.5 USD per hour
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Job Details
- Experience
- 1–3 years
- Required Skills
- Microsoft ExcelComplianceData entry
Requirements
- 1–3 years of experience in credentialing, provider enrollment, or healthcare revenue cycle operations.
- High school diploma, GED, or equivalent experience required.
- Familiarity with payer enrollment systems, CAQH, NPPES, PECOS, and state Medicaid portals strongly preferred.
- Strong attention to detail with the ability to manage complex data accurately and efficiently.
- Intermediate proficiency in Microsoft Excel and comfort working with multiple systems and databases.
- Excellent written and verbal communication skills with strong customer service orientation.
- Ability to prioritize tasks, meet deadlines, and manage time-sensitive workflows independently.
- Strong problem-solving skills with a proactive and inquisitive mindset.
- Ability to work both independently and collaboratively in a fast-paced environment.
- Openness to process improvement and innovation, including the use of new technologies.
Responsibilities
- Maintain and update CAQH profiles, ensuring provider data accuracy, timely attestations, and compliance with credentialing standards.
- Manage provider enrollment and credentialing workflows, including onboarding, updates, and ongoing maintenance of provider records.
- Submit and track provider applications through payer portals, ensuring timely processing and resolution of enrollment requests.
- Monitor credentialing timelines, license renewals, and provider updates to ensure all requirements are met without delay.
- Respond to payer requests for information accurately and promptly to support enrollment and verification processes.
- Collaborate with internal teams, external vendors, and healthcare partners to resolve enrollment issues and improve process efficiency.
- Maintain data integrity across systems such as CAQH, NPPES, PECOS, and payer databases.
- Identify and escalate risks, delays, or process gaps to leadership while ensuring timely resolution of outstanding issues.
- Support continuous improvement initiatives by identifying opportunities to enhance credentialing workflows and system efficiency.
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