Provider Enrollment Specialist

• →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.

• You are highly organized and rarely let details slip through the cracks.
• You navigate complex bureaucratic systems with patience and persistence.
• You thrive in focused, project-based work where you can see immediate results.
• You communicate clearly and concisely with clinicians, internal teams, and external payers.

• You prefer a permanent, long-term role rather than a six-month contract.
• You get frustrated by repetitive administrative processes and frequent payer follow-ups.
• You need a highly structured, slow-moving environment to feel comfortable.

• One to three years of experience in healthcare provider credentialing, payer enrollment, or managed care onboarding.
• High school diploma or GED.
• Demonstrated proficiency with payer enrollment portals like Availity, PECOS, and state Medicaid systems.
• 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.

• 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.

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. Expected compensation ranges for this role may change over time.