Credentialing and Provider Enrollment Specialist

The specialist will manage provider and group enrollment with Medicare, Medicaid, and commercial payers, maintain CAQH profiles, and track every application through approval. This role requires hands-on Medicare enrollment experience through PECOS, strong attention to detail, consistent follow-up, and experience working with U.S. health insurance plans.

• Prepare, submit, and track Medicare enrollment applications through PECOS, including individual, group, and reassignment of benefits applications
• Respond to Medicare Administrative Contractor development requests and correct application issues to keep enrollments moving
• Complete Medicaid and commercial payer credentialing and contracting applications for new and existing practice locations
• Create, update, and re-attest CAQH ProView profiles using provider-authorized access
• Maintain NPI, license, DEA, board certification, malpractice, and hospital privilege records with expiration dates
• Follow up with payers by phone, email, and portal until each application is approved and effective dates are confirmed
• Track application status, reference numbers, and effective dates in the practice's credentialing tracker
• Notify the practice of approvals, denials, missing documents, and upcoming revalidation or re-credentialing deadlines
• Process demographic updates such as new locations, address changes, and added services with each payer
• Protect patient and provider information and follow HIPAA requirements