Credentialing and Enrollments Specialist

Position Summary 

The Credentialing & Enrollments Specialist is responsible for managing the credentialing, payer enrollment, and provider onboarding processes for the practice’s physicians and advanced practice providers. This role ensures providers are credentialed, enrolled, and maintained with commercial and government payers in a timely and accurate manner to support uninterrupted billing and patient care operations. 

The specialist maintains provider records, monitors credentialing deadlines, coordinates with payers and providers, and serves as a key resource for credentialing and insurance operations. This position requires strong organizational skills, attention to detail, and the ability to manage multiple deadlines in a fast-paced healthcare environment. 

This role is non-exempt (hourly) and full-time, 40 hours per week, Monday through Friday. The position is remote, with preference for candidates residing in California, Arizona, Colorado, New Mexico, or South Carolina. Occasional overtime may be required to meet credentialing deadlines or business needs. 

Essential Duties & Responsibilities 

Credentialing & Payer Enrollments 

• Prepare, submit, and manage provider credentialing and payer enrollment applications for commercial, Medicare, Medicaid, and other health plans. 

• Coordinate initial credentialing, recredentialing, and provider data maintenance processes for physicians and advanced practice providers. 

• Maintain accurate and up-to-date provider files, including CAQH profiles, NPI information, state licenses, DEA certificates, malpractice insurance, board certifications, and other required documentation. 

• Maintain all credentialing, enrollment, and contracting records within CredentialStream and other designated databases. 

• Monitor credentialing and enrollment statuses through payer portals and follow up regularly to ensure timely approvals. 

• Track expiration dates for licenses, certifications, malpractice coverage, and other required documents to ensure continuous compliance. 

• Respond to payer requests for additional documentation or clarification in a timely manner. 

• Communicate credentialing and enrollment status updates to leadership, billing managers, clinic managers, providers, and other stakeholders as needed. 

• Assist with onboarding new providers, including coordinating credentialing timelines, payer enrollments, and hospital privileging requirements. 

• Support provider offboarding activities, including payer terminations and record updates. 

• Maintain confidentiality and ensure compliance with HIPAA and organizational policies at all times. 

Performance Expectations 

• Maintains complete, accurate, and organized credentialing and enrollment records. 

• Demonstrates timeliness and accuracy in application preparation and submission. 

• Effectively manages multiple provider enrollment timelines and deadlines. 

• Proactively identifies and resolves credentialing or enrollment delays. 

• Maintains professional communication with providers, payers, and internal departments. 

• Adheres to HIPAA, confidentiality, and compliance requirements at all times. 

Qualifications & Requirements 

Education 

• High school diploma or equivalent required. 

• Associate degree or higher preferred. 

Experience 

• Minimum of 2 years of experience in provider credentialing, payer enrollment, medical staff services, or healthcare administration required. 

• Experience with commercial and government payer enrollment processes strongly preferred. 

• Working knowledge of CAQH, PECOS, NPPES, and payer enrollment portals required. 

• Experience maintaining provider records and credentialing databases, including CredentialStream or similar credentialing software. 

• Experience with hospital privileging and provider onboarding preferred. 

• Prior experience in allergy, asthma, or specialty medical practices is a plus. 

Skills & Abilities 

• Strong attention to detail and organizational skills. 

• Excellent written and verbal communication skills. 

• Ability to prioritize tasks and manage multiple deadlines effectively. 

• Ability to work independently and collaboratively in a remote environment. 

• Proficiency in Microsoft Office Suite, EHR systems, practice management software, and online credentialing portals. 

• Strong problem-solving and follow-up skills. 

Compensation 

The hourly range will be discussed during the interview process. Actual compensation will be determined based on a variety of factors, including the candidate’s experience, education, skills, and qualifications.