Credentialing Specialist (Payer Enrollment)

The Credentialing Specialist (Payer Enrollment) is responsible for enrolling healthcare facilities with commercial insurance payers, Medicare, and Medicaid to ensure timely reimbursement for services rendered. Manage the application process, track credentialing status, and resolve enrollment issues. This role requires attention to detail, knowledge of healthcare regulations, and strong communication skills to coordinate with multiple internal departments and insurance companies effectively.
Essential Duties and Responsibilities:

Application Management: Prepare, submit, and track enrollment applications, re-credentialing packets, and demographic updates with commercial and government payers.
Payer Follow-up: Proactively communicate with insurance representatives to track application status, resolve processing errors, and shorten approval timelines.
Database Maintenance: Manage, update, and audit provider information in centralized databases like CAQH, PECOS, and NPPES.
Internal Collaboration: Coordinate with the broader billing, compliance, and operations teams to align enrollment data across the organization's practice management systems.
Denial Troubleshooting: Investigate and resolve claim rejections or delays that stem from provider enrollment or taxonomy errors.

Required Experience:

A minimum of two years of payer enrollment experience

Knowledge and Skills:

Knowledge and understanding of the credentialing and enrollment process
Strong familiarity with medical provider numbers such as NPI (National Provider Identifier) and TIN (Tax Identification Number).
Ability to organize and prioritize work and manage multiple priorities
Excellent verbal and written communication skills
Excellent attention to detail
Ability to establish and maintain effective working relationships with providers, management, staff, and contacts outside the organization.
Proficient use of Microsoft Office applications (Word, Excel, SharePoint) and credentialing software
MD Staff software experience a plus