Credentialing & Payor Enrollment Specialist

About the role

Credentialing & Enrollment Specialist supporting provider credentialing and enrollment processes to ensure timely insurance payor enrollment, impacting revenue cycle and provider relationships. This remote role may require travel, with a focus on delivering exceptional customer service and working collaboratively within teams.

Responsibilities

• Maintain and update CAQH profiles and provider records, manage credentialing deadlines, track onboarding activities, and collaborate with internal teams and external vendors.
• Enter provider applications into payer portals, verify data accuracy, respond to payor inquiries, and uphold confidentiality and regulatory standards.
• Develop relationships to improve processes, identify performance gaps, and propose solutions for efficiency and performance enhancement.
• Proficiently use HIS and enrollment software, including databases, payer portals, and licensing systems.
• Escalate issues beyond scope to leadership and support cross-departmental initiatives.

Qualifications & Skills

• 1-3 years of experience
• High attention to detail
• Excellent communication skills
• Proficiency in Excel
• Knowledge of enrollment systems such as PECOS and Medicaid portals
• Problem-solving mindset and openness to innovation are preferred

Benefits

Offers benefits, certifications, tuition reimbursement, and career growth opportunities.