Provider Enrollment

About the role

We are seeking a Credentialing & Provider Enrollment Specialist to join a leading healthcare organization in Philadelphia. This role is a unique opportunity to support a high-impact provider enrollment cleanup project while gaining exposure within a renowned healthcare system. Strong performers may have the opportunity to convert to a permanent position. Location: Philadelphia, PA. Schedule: Hybrid (Monday onsite, Tuesday-Friday remote). Hours: 40 hours per week. Type: Open-Ended Contract with Potential for Permanent Conversion.

Responsibilities

• Review and prepare provider enrollment and credentialing applications for accuracy and completeness.
• Submit enrollment packets to commercial and government payers in a timely manner.
• Maintain provider records, credential files, and enrollment databases.
• Follow up with providers to obtain required documentation for credentialing and re-credentialing.
• Monitor credential expiration dates and send renewal reminders at least 30 days prior to expiration.
• Perform CAQH re-attestations every 120 days for all providers.
• Maintain accurate provider information within NPPES and other credentialing systems.
• Communicate with insurance payers regarding application status and provider participation effective dates.
• Document all payer communications, correspondence, and follow-up activities.
• Research and provide support to the Billing Department regarding claims and enrollment-related issues.
• Scan, organize, and maintain credentialing documentation and records.

Qualifications

• 2+ years of experience in provider enrollment, medical insurance verification, billing, or provider relations.
• Knowledge of insurance billing and provider operations within a healthcare environment.
• Understanding of Medicare and Medicaid policies and procedures.
• Experience working with CAQH, Navinet, and ECHO.