Provider Credentialing & Contracting Specialist

Provider Credentialing & Contracting Specialist About the role Coordinate provider and location enrollment, maintain credentialing records, and follow up with payers on outstanding requirements before they affect billing. Responsibilities Prepare credentialing and re-credentialing submissions, track requirements, and follow up with commercial payers, Medicare (PECOS), and Medicaid. Maintain strict accuracy of CAQH profiles and provider rosters to prevent "provider not enrolled" claim edits. Track payer contract structures, fee schedules, and linked facility locations to support accurate expected-versus-paid variance reporting. Actively manage escalation paths for stalled payer enrollments, directly contacting payer representatives to resolve application exceptions. Audit and update internal systems to ensure billing teams have real-time visibility into effective dates and network participation status. Qualifications 3+ years of experience in healthcare credentialing, provider enrollment, or payer contracting for multi-specialty groups or facilities. Experience using CAQH, PECOS, and navigating complex commercial payer enrollment portals. Experience maintaining accurate provider records and resolving payer enrollment issues before they affect billing. Working arrangements Location: Remote (Strictly limited to MA, FL, CT, PA, Montreal or NC residents) #J-18808-Ljbffr Alicohealthcare