Enrollment/Credentialing Specialist

Description:

Position Summary

The Enrollment/Credentialing Specialist oversees the end-to-end process of enrolling medical providers with insurance payers (Medicare, Medicaid, and commercial carriers) to ensure timely reimbursement. This role also manages provider credentialing and privileging processes, maintains compliance, and ensures accurate provider data across systems.

Key Responsibilities

• Manage provider enrollment with Medicare, Medicaid, and commercial payers
• Maintain and update provider data in systems such as CAQH, PECOS, and credentialing platforms
• Track enrollment status and resolve denials or discrepancies
• Ensure all credentialing and privileging requirements are completed and up to date
• Verify licensure, certifications, education, and compliance documentation
• Maintain compliance with CMS, state regulations, and internal policies
• Support audits and ensure accurate, complete provider files
• Collaborate with revenue cycle and leadership to reduce delays and reimbursement issues

Requirements:

Education & Experience

• Preferred: Experience in healthcare credentialing, enrollment, or health information management
• Preferred: CPCS certification or related credential
• Equivalent combination of education and relevant experience will be considered

Knowledge, Skills, & Abilities

• Strong attention to detail and organizational skills
• Ability to manage multiple deadlines and high volumes of confidential data
• Strong analytical and problem-solving skills
• Excellent written and verbal communication skills
• Ability to work independently and take initiative
• Familiarity with payer enrollment processes and credentialing systems preferred