Credentialing & Enrollment Specialist
O
OpheliaHealthcare
United StatesFull-TimeMiddle
Salary65,000 - 67,000 USD per year
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Job Details
- Experience
- 3-5 years
- Required Skills
- Microsoft OfficeGoogle Workspace
Requirements
- Associates degree or equivalent combination of education and experience.
- 3-5 years of working experience in a credentialing and enrollment setting.
- Knowledge of multi-state/national provider credentialing and/or enrollment.
- Experience with PECOS/Medicare and/or state Medicaid enrollment platforms.
- Proficiency with Google Workspace/Microsoft Office or other task management suites.
- NAMSS Certified Provider Credentialing Specialist (CPCS) certification is a plus.
Responsibilities
- Review provider initial and reappointment credentialing applications to ensure compliance.
- Conduct primary source verification and coordinate the credentialing committee review process.
- Submit license, DEA, and CSR requests promptly.
- Follow up with providers to gather missing information for enrollment.
- Submit and monitor enrollment packets for MCOs, Medicare, and Medicaid.
- Enter and maintain accurate provider data in internal and external databases like CAQH.
- Act as a liaison between providers, payors, and internal teams to resolve credentialing issues.
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