Provider Enrollment & Credentialing Specialist

About the role

The Provider Enrollment & Credentialing Specialist is responsible for coordinating, preparing, submitting, tracking, and following up on provider credentialing and payor enrollment applications for physicians and advanced practice providers. This role supports enrollment with hospitals and ambulatory surgery centers, commercial insurance companies, government payors, and other applicable organizations where PAA provides patient care.

Responsibilities

• Prepare, submit, and monitor payor enrollment applications for physicians and advanced practice providers with commercial insurance carriers, Medicare, Medicaid, and other applicable payors.
• Career coordination of initial enrollment, re-enrollment, reappointments, demographic updates, terminations, and maintenance of provider participation records with insurance companies and payor portals.
• Completion and maintenance of electronic physician credentialing files, including licensure, board certification, DEA registrations, malpractice coverage, work history, education, training, references, and other required documentation.
• Tracking application status, follow-up with payors, facilities, providers, and internal departments, and provide timely updates regarding pending enrollment and credentialing matters.
• Maintenance of accurate and organized credentialing and enrollment records in applicable databases, credentialing software, spreadsheets, and provider files.
• Support compliance monitoring by ensuring provider files meet internal standards, payor requirements, facility standards, HIPAA requirements, and applicable regulatory guidelines.
• Respond to internal and external inquiries related to provider enrollment, credentialing status, documentation requests, and routine payor or facility matters.
• Preparation of reports, status updates, and tracking logs related to credentialing, payor enrollment, expirable, and compliance activity.
• Maintain confidentiality of provider and organizational information and ensure compliance with all Health Insurance Portability and Accountability Act (HIPAA) standards.
• Perform other duties as assigned within the scope of responsibility.

Qualifications

• High School Diploma or GED required; associate degree or additional coursework in healthcare administration, business administration, or a related field preferred.
• Two years of provider credentialing, payor enrollment, medical staff services, healthcare administration, or related experience preferred. Experience working with insurance carriers, Medicare, Medicaid, CAQH, PECOS, NPPES, and credentialing or enrollment systems is preferred.
• Certified Provider Credentialing Specialist (CPCS) or Provider Enrollment Specialist Certification (PESC) preferred.
• Demonstrated ability to exercise professional oral and written communication skills with all internal and external audiences.
• Proficiency with Microsoft Outlook, Word, and Excel required. Experience with credentialing software, payor portals, CAQH, PECOS, NPPES, and other enrollment platforms preferred.
• Strong attention to detail, organizational skills, follow-through, and ability to manage multiple deadlines. Ability to communicate professionally with providers, payors, facilities, and internal teams. Working knowledge of provider credentialing, payor enrollment processes, compliance requirements, and confidentiality standards. Ability to identify issues, resolve routine problems, and escalate matters appropriately.

Benefits

PAA offers competitive total rewards including salary, benefits – Day 1, retirement, profit sharing, life insurance, paid time off, holidays, education reimbursement, employee recognition for birthdays and anniversaries, fun team building events, and more.

Schedule

This position operates in a hybrid work environment, with employees typically working on site two to three days per week and performing routine office and computer-based work.

About Providence Anesthesiology Associates

Headquartered in Charlotte, North Carolina, Providence Anesthesiology Associates (PAA) is an independent physician owned practice compromised of over 150 anesthesiologists. Founded in 1991, PAA provides anesthesia and perioperative care at numerous healthcare facilities throughout North and South Carolina, serving more than 150,000 patients annually.

Why work for PAA?

PAA continues to experience impressive growth and success. Our anesthesiologists are among the most elite in their field. Our physicians are committed to providing the best culture and experience to their employees. Awarded one of the Top Workplaces in 2021, PAA’s core values include commitment, accountability, performance, integrity, transparency, adaptability, and leadership. We do what’s right and don’t compromise.

What’s in it for you?

We provide competitive total rewards including salary, benefits – Day 1, retirement, profit sharing, life insurance, paid time off, holidays, education reimbursement, employee recognition for birthdays and anniversaries, fun team building events, and more.

Equal Opportunity Employer

PAA is an equal opportunity employer and does not tolerate discrimination based on any protected status.