Payor Credentialing and Enrollment Specialist

Payor Credentialing & Enrollment SpecialistJob SummaryCapitol Imaging Services, we’re a leading provider of diagnostic imaging services committed to delivering high-quality patient care through innovation and a compassionate approach. Our high-quality radiology services include—MRI, CT, PET/CT, Nuclear Medicine, ultrasound, X-ray, and mammography. We are currently operating 60 facilities across six states in the Gulf Coast region.The Payor Credentialing & Enrollment Specialist is responsible for managing facility and provider enrollment with government and commercial payers to support accurate participation, clean claims, and timely reimbursement. This fully remote role owns payor enrollment submissions, revalidations, credentialing documentation, payer portal maintenance, effective-date tracking, and ongoing enrollment compliance. The position also works closely with billing, revenue cycle, and operational leadership to resolve enrollment-related denials, address reimbursement delays, reduce avoidable write-offs, and strengthen workflows that prevent recurring payor setup and participation issues.Key ResponsibilitiesPayor Enrollment, Participation & Revenue Cycle SupportManage enrollment-related workflows that support timely payor participation, accurate payer setup, clean claim submission, and appropriate reimbursement.Research and resolve enrollment-driven denials, non-payment, effective-date discrepancies, payer participation issues, and reimbursement delays across modalities, payors, and sitesDevelop practical solutions that prevent recurring credentialing, enrollment, payor participation, and claims-processing issuesConvert denial and reimbursement trends into actionable enrollment workflows, payer-specific guidance, and standard operating proceduresConduct payor follow-up to resolve missing documentation, application deficiencies, effective-date issues, participation discrepancies, claim denials, and payment variances.Investigate and resolve enrollment or payer setup issues causing delays in payment or reimbursement to support accurate claims processingPartner with revenue cycle teams to identify recurring denial patterns and recommend enrollment-focused process improvements that reduce AR delays and avoidable write-offsMonitor enrollment-related accounts receivable issues and escalate payor participation or credentialing barriers that impact reimbursementCredentialing, Application Management & Enrollment MaintenanceCollect, verify, and maintain facility and provider documentation required for credentialing, enrollment, contracting support, and payor participationPrepare, submit, and track initial enrollment, revalidation, re-credentialing, demographic update, and payor maintenance applications in accordance with organizational, payor, and regulatory requirementsMaintain accurate and complete electronic credentialing filesTrack credential expiration dates and proactively manage renewals to prevent lapsesComplete and submit provider enrollment applications for Medicare, Medicaid, and commercial payorsManage enrollments using CAQH, PECOS, NPPES, and payor-specific portalsConduct regular follow-ups with payors to resolve delays, missing documentation, or application deficienciesConfirm provider participation status and effective dates with each payorMaintain current payor fee schedule information and communicate payer setup or reimbursement concerns to appropriate revenue cycle stakeholders.Maintenance & ComplianceUpdate payors with changes to provider demographics, locations, group affiliations, and tax informationEnsure ongoing compliance with federal, state, and payor requirementsMaintain documentation for audits and internal reviewsPartner with billing, revenue cycle, operations, and leadership teams to resolve credentialing- or enrollment-related claim issues and prevent recurring reimbursement disruptionRemote Work ExpectationsMaintain reliable internet access and a secure, HIPAA-compliant remote work environmentCommunicate effectively with internal teams via email, phone, and virtual meetingsManage workload independently while meeting deadlines and productivity expectationsQualificationsRequiredExperience in healthcare payor enrollment, provider or facility credentialing, enrollment maintenance, reimbursement support, or revenue cycle operations; radiology or diagnostic imaging experience preferred5+ years of experience in provider credentialing, payor enrollment, application tracking, enrollment maintenance, payor follow-up, and denial or reimbursement issue resolutionStrong knowledge of Medicare, Medicaid, and commercial insurance enrollment processesDemonstrated ability to research enrollment-related claim denials, resolve reimbursement delays, reduce avoidable write-offs, and recommend process improvementsAbility to manage multiple providers and deadlines independently in a remote settingExcellent written and verbal communication skillsSkills & CompetenciesHighly detail-oriented and deadline-drivenComfortable with frequent payor follow-up, payer portal research, documentation tracking, enrollment status monitoring, and revenue cycle issue resolutionProficient with Microsoft Office and web-based systemsSelf-motivated and able to work independently in a remote environmentAlways maintains confidentiality and professionalism #J-18808-Ljbffr