Credentialing Enrollment Lead

Prime Credential is seeking a diligent and detail-oriented Credentialing Enrollment Lead to manage and oversee the enrollment and credentialing processes for healthcare providers. This role combines hands‑on credentialing execution with team leadership responsibilities, including helping manage day‑to‑day credentialing delivery across assigned team members. This position focuses on ensuring timely enrollment with Medicare and commercial payers such as Aetna, Blue Cross, and Cigna, primarily in an outpatient healthcare setting. The ideal candidate is highly organized, thrives in a remote work environment, and has experience with payer‑specific processes and requirements while also being comfortable guiding teammates, prioritizing work, and helping drive accountability across the credentialing function. Key Responsibilities Credentialing Delivery & Team Leadership Help lead daily credentialing and enrollment operations across assigned team members, ensuring work is completed accurately, on time, and in alignment with client expectations. Serve as a senior resource for the credentialing team by answering questions, reviewing work, helping remove blockers, and supporting consistent execution across accounts. Assist in managing team workflows, task prioritization, and coverage to ensure smooth credentialing delivery across clients and providers. Monitor team performance, turnaround times, and open items, escalating risks or delays as needed. Train and support newer team members on credentialing processes, payer requirements, documentation standards, and internal workflows. Personally manage a portfolio of credentialing and enrollment work in addition to lead responsibilities. Primary Liaison for Provider Enrollment Act as the primary liaison for provider enrollment with Medicare, Medicaid, and commercial payers such as Aetna, Blue Cross, and Cigna. Coordinate initial enrollment, re‑credentialing, and updates for providers in an outpatient care setting. Prepare and submit accurate enrollment applications, ensuring all required provider documentation is included and up to date, including licenses, NPI, insurance, and W‑9 forms. Monitor the approval process and follow up with payers to ensure seamless enrollment and minimize delays in claim submissions. Handle more complex or escalated enrollment and credentialing cases as needed. Regulatory Compliance Ensure all credentialing activities comply with CMS requirements, state laws, and payer‑specific regulations. Stay updated on changes to Medicare, Medicaid, and commercial payer policies to avoid disruptions in provider enrollment. Manage and maintain compliance with revalidation timelines, ensuring Prime Credential maintains active status with all payers. Help ensure team adherence to internal quality standards, documentation requirements, and compliance expectations. Provider Relations & Support Serve as a resource for providers by addressing their enrollment questions or concerns. Proactively communicate with providers about needed documentation, status updates, and next steps in the enrollment process. Provide support to internal stakeholders in resolving payer‑related credentialing issues and claim submission delays resulting from enrollment issues. Support team communications with clients and providers to ensure clear, professional, and timely follow‑through. Data Management Maintain accurate and organized records of all enrollment and credentialing activities in credentialing software or databases. Regularly update internal systems with provider and payer‑specific information such as Medicare PTANs or commercial payer IDs. Generate reports on enrollment status, credentialing completion timelines, and payer relationships. Track team and account‑level progress, open issues, and key deadlines to support operational visibility and follow‑up. Process Improvement Identify opportunities to streamline credentialing and enrollment workflows to improve efficiency and processing times. Collaborate with key stakeholders to troubleshoot and resolve payer‑related bottlenecks. Recommend and help implement improvements to team workflows, QA processes, and credentialing operating procedures. Qualifications Education High school diploma or GED required. An associate’s or bachelor’s degree in healthcare administration, business, or a related field is preferred. Experience Minimum 5 years of experience in provider enrollment or payer‑focused credentialing with Medicare and commercial payers such as Aetna, Blue Cross, and Cigna. Strong understanding of outpatient care settings and payer‑specific enrollment workflows. Experience working with databases and credentialing software, such as CAQH and PECOS highly preferred. Prior experience serving as a senior team member, lead, trainer, or informal people manager within a credentialing or healthcare operations team is strongly preferred. Experience handling escalations, balancing multiple priorities, and helping coordinate work across a team is preferred. Attention to detail: Ability to manage complex documentation and ensure accuracy in payer applications. Organizational skills: Skilled in managing multiple tasks and deadlines in a fast‑paced, remote setting. Communication: Strong written and verbal communication skills to interact professionally with payers, providers, and internal teams. Problem‑solving: Adept at troubleshooting enrollment challenges and proactively resolving delays. Tech proficiency: Proficient in Microsoft Office Suite, including Word, Excel, and Outlook, and familiar with credentialing management tools. Leadership: Ability to coach teammates, coordinate workflows, and help drive consistent execution across the team. Ownership: Comfortable balancing individual production responsibilities with lead‑level oversight and support. Knowledge of Industry Standards In-depth understanding of Medicare and Medicaid enrollment requirements and processes. Experience managing enrollments with major commercial payers such as Aetna, Blue Cross, and Cigna. Familiarity with outpatient care workflows and how they intersect with payer credentialing. Working Conditions Fully remote position with flexibility to work from home while maintaining a collaborative connection with the credentialing team. Ability to manage time effectively and self‑prioritize tasks in a remote environment. Occasional availability for video conferencing or team calls during business hours. Ability to support team coordination and responsiveness during core business hours. #J-18808-Ljbffr Prime Credential