Provider Enrollment & Credentialing Specialist

Job Description

Job Description

Description:

Job Title: Provider Enrollment & Credentialing Specialist

Also referred to as: Credentialing Specialist, Enrollment Coordinator, Provider Services Coordinator  

Location: Charlotte,  Hybrid, requiring 2 to 3 days in the office 
Job Type: Full-time 

SUMMARY: The  Provider Enrollment & Credentialing Specialist is responsible for coordinating, preparing, submitting, tracking, and following up on provider credentialing and payor enrollment applications for physicians and advanced practice providers. This role supports enrollment with hospitals and ambulatory surgery centers, commercial insurance companies, government payors, and other applicable organizations where PAA provides patient care. 

The  Provider Enrollment & Credentialing Specialist also maintains accurate provider files and enrollment records, including revalidations, licensure, certifications, and related documentation, to support ongoing compliance with organizational, payor, and regulatory requirements. This position requires integrity, attention to detail, dependability, initiative, and a commitment to embracing company values.

Essential duties and Responsibilities

Duties include but are not limited to:

• Prepare, submit, and monitor payor enrollment applications for physicians and advanced practice providers with commercial insurance carriers, Medicare, Medicaid, and other applicable payors.
• Coordinate initial enrollment, re-enrollment, reappointments, demographic updates, terminations, and maintenance of provider participation records with insurance companies and payor portals.
• Complete and maintain electronic physician credentialing files, including licensure, board certification, DEA registrations, malpractice coverage, work history, education, training, references, and other required documentation.
• Track application status, follow up with payors, facilities, providers, and internal departments, and provide timely updates regarding pending enrollment and credentialing matters.
• Monitor credentialing and enrollment deadlines to ensure timely renewals, reappointments, revalidations, and compliance with payor and facility requirements. 
• Review provider profiles and enrollment records to identify discrepancies, missing information, or potential issues; initiate corrective action and escalate concerns as appropriate.
• Coordinate with physicians, advanced practice providers, managers, billing staff, and administrative teams to obtain signatures, documentation, and information required for credentialing and payor enrollment.
• Maintain accurate and organized credentialing and enrollment records in applicable databases, credentialing software, spreadsheets, and provider files.
• Support compliance monitoring by ensuring provider files meet internal standards, payor requirements, facility standards, HIPAA requirements, and applicable regulatory guidelines.
• Respond to internal and external inquiries related to provider enrollment, credentialing status, documentation requests, and routine payor or facility matters. 
• Prepare reports, status updates, and tracking logs related to credentialing, payor enrollment, expirable, and compliance activity.
• Maintain confidentiality of provider and organizational information and ensure compliance with all Health Insurance Portability and Accountability Act (HIPAA) standards.
• Perform other duties as assigned within the scope of responsibility.

Minimum Qualifications

To perform this job successfully an individual must be able to perform each essential duty to a satisfactory standard. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Education: High School Diploma or GED required; associate degree or additional coursework in healthcare administration, business administration, or a related field preferred. 

Experience: Two years of provider credentialing, payor enrollment, medical staff services, healthcare administration, or related experience preferred. Experience working with insurance carriers, Medicare, Medicaid, CAQH, PECOS, NPPES, and credentialing or enrollment systems is preferred. 

License/Certification: Certified Provider Credentialing Specialist (CPCS) or Provider Enrollment Specialist Certification (PESC) preferred. 

Communication Skills: Demonstrated ability to exercise professional oral and written communication skills with all internal and external audiences. 

Computer Skills: Proficiency with Microsoft Outlook, Word, and Excel required. Experience with credentialing software, payor portals, CAQH, PECOS, NPPES, and other enrollment platforms preferred. 

Knowledge, Skills, and Abilities: Strong attention to detail, organizational skills, follow-through, and ability to manage multiple deadlines. Ability to communicate professionally with providers, payors, facilities, and internal teams. Working knowledge of provider credentialing, payor enrollment processes, compliance requirements, and confidentiality standards. Ability to identify issues, resolve routine problems, and escalate matters appropriately.

Physical Demands and Work Environment

The physical demands described here are representative of those that must be met by any employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

This position operates in a hybrid work environment, with employees typically working on site two to three days per week and performing routine office and computer-based work. The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. While performing the duties of this position, the employee is regularly required to sit, stand, walk, use hands to handle documents or operate a computer, reach with hands and arms, and talk or hear. The role involves routine computer and desk work and may require occasional light lifting. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.

About Providence Anesthesiology Associates

Headquartered in Charlotte, North Carolina, Providence Anesthesiology Associates (PAA) is an independent physician owned practice compromised of over 150 anesthesiologists. Founded in 1991, PAA provides anesthesia and perioperative care at numerous healthcare facilities throughout North and South Carolina, serving more than 150,000 patients annually.

Why work for PAA?

• PAA continues to experience impressive growth and success. Our anesthesiologists are among the most elite in their field.
• Our physicians are committed to providing the best culture and experience to their employees. Awarded one of the Top Workplaces in 2021, PAA’s core values include commitment, accountability, performance, integrity, transparency, adaptability, and leadership. We do what’s right and don’t compromise.

What’s in it for you?

• Strong workplace culture. We care about each other as people. We build relationships and connections beyond the time spent on the job. We offer a supportive, highly team-oriented work environment.
• We provide competitive total rewards including salary, benefits – Day 1, retirement, profit sharing, life insurance, paid time off, holidays, education reimbursement, employee recognition for birthdays and anniversaries, fun team building events, and more.
• We want you to succeed and our employer to employee relationship is proven to help you reach your goals and the goals of PAA.

What else should you know?

• Providence Anesthesiology Associates is an equal opportunity employer and does not tolerate discrimination based on any protected status.
• PAA participates in E-Verify. E-Verify is an internet-based system that compares the information you provide on the Form I-9 with information from the Social Security Administration and Department of Homeland Security records.