The Credentialing & Enrollment Specialist facilitates and manages the credentialing and enrollment process from start to finish. This role requires a variety of tasks such as enrolling new providers, maintaining CAQH profiles, auditing payer directories, and adhering to HIPAA guidelines. It also involves daily communication with different parties including payers, internal teams, and providers.
Responsibilities:
Enroll and revalidate providers with payers
Submit enrollment applications
Ensure timely application processing
follow up on application processing
Update provider information in databases
Manage CAQH profiles and facilitate re-attestations
Collaborate with teams and customers
Adhere to HIPAA guidelines
Audit and update payer directories
Verify enrollment status and instructions
Maintain provider information in databases
Qualifications:
Experience:
2-4 years in credentialing
Healthcare sector experience
Customer Service and Revenue Cycle Management experience
Proficiency in CAQH, NPPES, and PECOS
Skills:
Task-oriented with strong attention to detail
Excellent in documentation and communication
Ability to prioritize, manage time, and work effectively both individually and in a team
Traits:
Persistent, unafraid to ask questions
Benefits:
401(k)
401(k) matching
Health insurance
Dental insurance
Vision insurance
Disability insurance
Life insurance
Flexible spending account
Employee assistance program
Flexible schedule
Paid time-off
Schedule: Dayshift (remote based)
