Credentialing and Provider Enrollment Specialist
New
R
RCM Staff BPOHealthcare credentialing
Source API remote eligibility restrictions: United States, Must be available during Eastern Time business hoursPart-TimeJunior
Salary not disclosed
Apply NowOpens the employer's application page
Job Details
- Languages
- Strong written and spoken English
- Experience
- At least 2 years of experience with U.S. healthcare credentialing and provider enrollment
- Required Skills
- HIPAA
Requirements
- Have at least 2 years of experience with U.S. healthcare credentialing and provider enrollment.
- Have hands-on experience submitting and managing Medicare applications in PECOS, including CMS-855 enrollment and reassignment.
- Be familiar with commercial insurance and government health plans.
- Have experience with CAQH ProView, NPPES, and payer enrollment portals.
- Have strong written and spoken English.
- Demonstrate excellent attention to detail and follow-up skills.
- Be able to work independently and manage multiple applications and deadlines.
- Have a reliable internet connection and suitable remote workspace.
- Be available during Eastern Time business hours.
- Preferred: Experience credentialing surgeons or specialty practices such as orthopedics, spine, or pain management.
- Preferred: Experience enrolling a newly formed group practice, including multiple locations.
- Preferred: Familiarity with Georgia Medicaid and Georgia commercial insurance plans.
- Preferred: Experience with hospital and ambulatory surgery center privileging.
Responsibilities
- Prepare, submit, and track Medicare enrollment applications through PECOS, including individual, group, and reassignment of benefits applications.
- Respond to Medicare Administrative Contractor development requests and correct application issues.
- Complete Medicaid and commercial payer credentialing and contracting applications for new and existing practice locations.
- Create, update, and re-attest CAQH ProView profiles using provider-authorized access.
- Maintain NPI, license, DEA, board certification, malpractice, and hospital privilege records with expiration dates.
- Follow up with payers by phone, email, and portal until applications are approved and effective dates are confirmed.
- Track application status, reference numbers, and effective dates in the practice's credentialing tracker.
- Notify the practice of approvals, denials, missing documents, and upcoming revalidation or re-credentialing deadlines.
- Process payer demographic updates, including new locations, address changes, and added services.
- Protect patient and provider information and follow HIPAA requirements.
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