Credentialing & Enrollment Specialist
New
J
JobgetherHealthcare Technology
Based in the 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
- Associate degree or equivalent combination of education and professional experience.
- 3–5 years of experience working in provider credentialing and enrollment.
- Experience managing multi-state or national provider credentialing processes.
- Knowledge of Medicare, Medicaid, and managed care organization enrollment requirements.
- Experience using platforms such as PECOS, CAQH, and payor enrollment portals.
- Familiarity with healthcare provider licensing, credentialing standards, and compliance requirements.
- Strong attention to detail with the ability to maintain accurate documentation and records.
- Excellent organizational skills and ability to manage multiple deadlines and priorities.
- Strong written and verbal communication skills.
- Proficiency with Google Workspace, Microsoft Office, or similar productivity and task management tools.
- Certified Provider Credentialing Specialist (CPCS) certification is a plus.
Responsibilities
- Review provider initial credentialing and reappointment applications to ensure completeness, accuracy, and compliance.
- Perform primary source verification and coordinate credentialing committee review processes.
- Manage licensing, DEA, and controlled substance registration renewals.
- Collect missing provider documentation and information for enrollment submissions.
- Prepare and submit enrollment applications to healthcare payors including Medicare, Medicaid, and commercial plans.
- Monitor enrollment progress, follow up with payors, and resolve delays.
- Maintain accurate provider records within databases, including CAQH and payor portals.
- Act as a key point of contact between providers, payors, and internal teams to resolve credentialing, enrollment, and reimbursement-related issues.
- Collaborate with Clinical Operations, Billing, and Contracting teams.
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