Support credentialing and enrollment processes to ensure all strategic partner providers are enrolled with insurance payors timely and efficiently
Updates and maintains CAQH profiles to ensure data is accurate, attestations are current and do not expire
Maintains accurate provider records and makes edits to provider profiles
Enters new providers and updates data, as needed
Manages time-sensitive credentials and takes a proactive approach to license renewals and annual provider or location updates
Enters tracking and conducts timely follow-up, staying focused on completion of provider onboarding activities
Supports strategic partners and internal counterparts to answer inquiries and provides enrollment and credentialing updates
Works as a team with outside vendors and facilities who share the goal of enrolling our providers
Escalates to Credentialing and Enrollments leadership any issues that require resolution beyond the Credentialing & Enrollment Specialist’s scope of responsibility

1 to 3 Years Experience
Knowledge and understanding of Provider Enrollment, Chain, and Ownership System (PECOS)
Knowledge and understanding of State Medicaid Portals
Experience working with insurance enrollments, strongly preferred
Intermediate proficiency level in Excel
High level of attention to detail with the ability to solve problems and function independently
Strong verbal and written communication skills
Must be inquisitive and demonstrate openness to innovation including AI to explore better processes and ways to alleviate friction and improve patient and client experiences

Credentialing and Payor Enrollment Specialist

Key skills