Provider Enrollment, Credentialing & Contract

We are looking for a detail-oriented individual to support provider enrollment, credentialing, and contracting activities for a healthcare organization in Davie, Florida. This contract position with the potential to become permanent is focused on ensuring providers are properly enrolled, credentialed, and maintained with payers and related entities so services can be delivered without reimbursement delays. The role begins fully onsite for at least the first three months, with the possibility of a hybrid schedule afterward based on business approval. Success in this position requires strong knowledge of claims workflows, payer requirements, and electronic health record and claims management systems such as Epic, NextGen, or similar platforms.

Responsibilities:
• Review provider application materials, verify required documentation through primary source research, and manage credentialing and recredentialing submissions through completion.
• Process enrollments and revalidations with Medicare, Medicaid, managed care plans, commercial carriers, and other third-party payers while tracking progress and following up on outstanding items.
• Coordinate hospital privilege applications, reappointments, and related payment requests to help maintain uninterrupted provider status.
• Maintain accurate, secure, and audit-ready provider files, enrollment records, calendars, and participation logs across internal systems and payer portals.
• Partner with payers and internal teams to handle provider additions, terminations, demographic changes, and location updates tied to network participation.
• Investigate and resolve enrollment-related denials, payment holds, and claim issues in collaboration with revenue cycle and operational departments.
• Support delegated credentialing reviews, internal audits, and payer inquiries to confirm provider directory data and participation records remain current.
• Monitor policy and procedural updates from health plans and communicate relevant changes to impacted staff members.
• Assist with contracting activities, including payer agreement updates, amendments, and special projects or process improvement initiatives as assigned.• Hands-on experience in provider enrollment, credentialing, contracting, medical claims, medical billing, or related healthcare administration functions.
• Working knowledge of government and commercial payer enrollment processes, including Medicare, Medicaid, Medicare Advantage, and managed care plans.
• Experience using electronic health record systems and claims management platforms such as Epic, NextGen, or comparable applications.
• Familiarity with resolving insurance claim issues connected to provider enrollment, claim administration, and medical insurance verification.
• Ability to manage multiple applications, revalidation deadlines, and follow-up activities with strong attention to detail and accuracy.
• Strong written and verbal communication skills for coordinating with payers, providers, and internal stakeholders.
• Understanding of compliance, document control, and audit readiness within provider files and enrollment records.