Credentialing & Enrollment Specialist

Credentialing & Enrollment Specialist II

This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for a Credentialing & Enrollment Specialist II based in United States.

This role is an experienced production position supporting the credentialing and enrollment of a growing national provider network. You'll manage end-to-end credentialing and payer enrollment activities with minimal supervision, including complex provider lifecycle cases. The position plays a key role in maintaining provider readiness, accurate records, compliant documentation, and timely payer activation. You'll work across credentialing, enrollment, provider operations, and revenue-related processes to help ensure seamless provider participation. The role also provides opportunities to support colleagues, contribute specialized knowledge, and strengthen team processes. Success requires strong organization, attention to detail, and the ability to manage multiple deadlines in a fast-paced healthcare environment. This is a fully remote opportunity within the United States, offering flexibility while contributing to a mission-driven organization.

Accountabilities:

• Execute provider onboarding readiness activities, including intake packet reviews and completeness checks.
• Prepare and submit initial credentialing and re-credentialing applications, and monitor primary source verifications through CVO.
• Perform primary source verification in accordance with departmental policies and applicable NCQA standards when required.
• Review CVO-processed files for completeness, accuracy, and compliance.
• Process provider status changes, terminations, and reactivations while collecting and following up on outstanding documentation.
• Track provider expirables, renewal requirements, malpractice policies, and insurance documentation to maintain ongoing compliance.
• Complete and submit individual and group enrollment applications to commercial and government payers.
• Monitor enrollment applications through completion, manage roster additions and updates, correct discrepancies, and process terminations as directed.
• Maintain CAQH, PECOS, payer portals, credentialing platforms, internal trackers, payer contact lists, and related provider data.
• Handle provider communications, status inquiries, documentation guidance, and issue intake while ensuring timely follow-up.
• Support enrollment-related claim denial triage, billing activation coordination, and resolution of roster-related billing issues.
• Prepare delegated credentialing files, gather audit evidence, perform credentialing file quality assurance, and maintain accurate records.
• Serve as a knowledgeable resource for Credentialing Specialist I colleagues and take on limited subject matter expert responsibilities when needed.

Requirements:

• 3+ years of professional experience in credentialing and/or payer enrollment operations.
• Working knowledge of NCQA standards, CAQH, and healthcare payer enrollment processes.
• Experience with both commercial and government payer enrollment is preferred.
• Proficiency with payer and healthcare portals, including CAQH, PECOS, Availity, and payer-specific platforms.
• Experience managing provider documentation, primary source verification, credentialing files, and enrollment records.
• Strong attention to detail with disciplined documentation and data management habits.
• Ability to manage multiple provider cases, priorities, and deadlines consistently with minimal supervision.
• Strong organizational and follow-up skills, particularly when coordinating with providers, payers, CVOs, and internal stakeholders.
• Ability to identify discrepancies, resolve issues, and maintain accurate provider information across multiple systems.
• Comfortable working independently in a fully remote environment while collaborating effectively with cross-functional teams.
• Willingness to act as a resource and informal subject matter expert for less-experienced team members.

Benefits:

• Competitive salary, with final compensation based on factors such as location, experience, and expertise.
• Fully paid comprehensive medical, dental, and vision coverage.
• Pet insurance.
• Life insurance and short- and long-term disability coverage.
• 401(k) plan.
• Unlimited paid time off and sick leave.
• Parental leave.
• Fully remote work within the United States.
• Flexible scheduling to support individual working preferences.
• Additional memberships, employee perks, and professional benefits.
• Mission-driven, inclusive environment focused on collaboration, continuous learning, and meaningful impact.
• Opportunity to work cross-functionally with professionals across healthcare, clinical, product, and technology teams.