Provider Enrollment Specialist

About the role

Delivering rapid, high-quality care requires our clinicians to be fully credentialed and ready to practice. Payer enrollment delays can bottleneck that mission. As a Provider Enrollment Specialist, you will step in for a focused, six-month contract to clear existing enrollment backlogs and streamline our payer application workflows.

You will own the end-to-end credentialing process, working directly with Managed Care Organizations (MCOs) and state Medicaid programs. This role requires navigating complex payer portals, managing CAQH profiles, and acting as the primary point of contact for health plan representatives.

By removing administrative friction, you will ensure our practitioners maintain active network participation. Your work directly accelerates our ability to deploy clinical capacity where it is needed most.

Responsibilities

• Executing initial enrollment applications and re-credentialing packets with commercial and government healthcare payers.
• Maintaining, updating, and attesting CAQH profiles, NPI data, and Tax Identification Number (TIN) attachments to prevent coverage lapses.
• Tracking pending enrollment applications with MCOs and health plans to expedite processing and secure official effective dates.
• Ensuring all provider enrollment files meet MCO standards and regulatory guidelines from bodies like NCQA and URAC.
• Serving as the primary operational contact for health plan enrollment representatives regarding application status, roster updates, and credentialing inquiries.

Qualifications

• One to three years of experience in healthcare provider credentialing, payer enrollment, or managed care onboarding.
• A high school diploma or GED.
• Demonstrated proficiency with payer enrollment portals like Availity, PECOS, and state Medicaid systems.
• A deep understanding of payer-specific credentialing rules, state licensing standards, and enrollment timelines.
• Strong analytical skills to identify missing documentation and resolve enrollment delays independently.

Bonus Points

• Bachelor’s degree.
• Certified Provider Credentialing Specialist (CPCS) or Certified Professional Medical Services Management (CPMSM) certification.
• Experience working with virtual care platforms or multi-state telehealth providers.

Pay

The national pay range for this role is $22.00 – $35.00 per hour. Actual compensation will be determined by factors such as the candidate's geographic market, experience, skills, and qualifications. If your compensation requirement is greater than our posted range, please still consider applying; a determination can be made based on unique qualifications.