Provider Enrollment & Credentialing Specialist

Job Summary

We are seeking a detail-oriented and motivated Provider Enrollment Credentialing Specialist to support the provider credentialing and payer enrollment process. The ideal candidate will have at least 1 year of hands-on experience working with commercial payers, Medicare, Medicaid, and regulatory agencies. This role is responsible for assisting in the preparation, submission, and tracking of credentialing and re-credentialing applications to ensure timely approvals and uninterrupted billing operations. This position requires strong organizational skills, accuracy, and the ability to manage multiple enrollments while maintaining compliance with regulatory standards.

Responsibilities

• Prepare, submit, and track initial credentialing and re-credentialing applications with commercial payers, Medicare, Medicaid, and regulatory agencies.
• Maintain accurate and up-to-date provider records, including state licenses, DEA registrations, board certifications, malpractice insurance, and CAQH profiles.
• Update and maintain provider information in NPPES and PECOS systems.
• Monitor credentialing and enrollment timelines and follow up with payer representatives to ensure timely processing.
• Navi gate credentialing software and web-based payer portals for application submissions and status tracking.
• Support multi-state provider enrollments under supervision when needed.
• Assist in resolving enrollment delays, rejections, and denials by coordinating with payers and internal stakeholders.
• Communicate effectively with providers, internal departments, and payer contacts regarding credentialing status.
• Ensure all documentation is complete, accurate, and audit-ready.

Requirements

• 1+ year of experience in Provider Enrollment Credentialing Specialist.
• Working knowledge of CAQH, NPPES, PECOS, Medicare Medicaid portals, and commercial payer portals.
• Basic understanding of healthcare compliance and regulatory requirements.
• Strong attention to detail and organizational skills.
• Good written and verbal communication skills.
• Ability to manage multiple tasks and meet deadlines in a fast-paced environment.
• Proficiency in Microsoft Office (Excel, Word, Outlook).

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