Credentialing & Enrollment Specialist

Credentialing & Enrollment Specialist

This role supports a mission-driven healthcare organization by ensuring providers are properly credentialed and enrolled to deliver high-quality patient care. You will manage critical processes that connect clinicians with healthcare networks, payors, and reimbursement systems. Working across clinical operations, billing, and contracting teams, you will help maintain accurate provider information and operational efficiency. The position requires strong attention to detail, knowledge of healthcare enrollment processes, and the ability to manage multiple priorities. You will play an essential role in supporting access to care by ensuring providers are ready to serve patients without administrative barriers. This is an opportunity to contribute to a growing healthcare technology environment focused on improving patient outcomes.

Accountabilities:

The Credentialing & Enrollment Specialist will oversee provider credentialing, re-credentialing, and enrollment activities while ensuring compliance with industry standards and maintaining accurate records across internal and external systems.

• Review provider initial credentialing and reappointment applications to ensure completeness, accuracy, and compliance with requirements.
• Perform primary source verification and coordinate credentialing committee review processes.
• Manage licensing, DEA, and controlled substance registration renewals to ensure timely submissions and compliance.
• Collect missing provider documentation and information needed for enrollment submissions.
• Prepare and submit enrollment applications to healthcare payors, including managed care organizations, Medicare, Medicaid, and commercial plans.
• Monitor enrollment progress, follow up with payors, and resolve delays to accelerate approval timelines.
• Maintain accurate provider records within databases, including CAQH and payor portals, updating demographics, practice locations, provider status, and required forms.
• Act as a key point of contact between providers, payors, and internal teams to resolve credentialing, enrollment, and reimbursement-related issues.
• Collaborate with Clinical Operations, Billing, and Contracting teams to support smooth healthcare delivery processes.
• Perform additional operational tasks as needed to support team objectives.

Requirements:

• Associate degree or equivalent combination of education and professional experience.
• 35 years of experience working in provider credentialing and enrollment.
• Experience managing multi-state or national provider credentialing processes.
• Knowledge of Medicare, Medicaid, and managed care organization enrollment requirements.
• Experience using platforms such as PECOS, CAQH, and payor enrollment portals.
• Familiarity with healthcare provider licensing, credentialing standards, and compliance requirements.
• Strong attention to detail with the ability to maintain accurate documentation and records.
• Excellent organizational skills and ability to manage multiple deadlines and priorities.
• Strong written and verbal communication skills when collaborating with providers, payors, and internal stakeholders.
• Proficiency with Google Workspace, Microsoft Office, or similar productivity and task management tools.
• Certification such as Certified Provider Credentialing Specialist (CPCS) from the National Association Medical Staff Services (NAMSS) is a plus.

Benefits:

• Competitive salary range of $65,000 - $67,000 USD.
• Comprehensive medical, vision, and health insurance plans, with many options fully covered for employees.
• Flexible remote work environment.
• Work-from-home stipend.
• 20 days of paid time off to start, increasing to 25 days after 2 years and 30 days after 5 years of tenure.
• 10 company-paid holidays.
• 401(k) contribution platform.
• Life insurance coverage.
• Short-term and long-term disability benefits.
• Financial wellness resources.
• Virtual primary care benefits.
• Employee assistance program and additional employee support resources.