Provider Enrollment & Credentialing Specialist

The Provider Enrollment & Credentialing Specialist serves as a key resource for provider enrollment, credentialing, and payer-related processes. This role is responsible for coordinating enrollment applications, maintaining provider records, monitoring credential and license renewals, and ensuring compliance with government and commercial payer requirements.

The specialist works closely with revenue cycle, billing, and operational teams to resolve enrollment-related issues, support provider onboarding, maintain credentialing databases, and monitor application statuses. Strong attention to detail, organization, and healthcare administrative knowledge are essential for success in this position.

This role is ideal for candidates with experience in provider enrollment, credentialing, medical billing, revenue cycle operations, healthcare administration, or insurance-related workflows.

### Key Responsibilities

* Serve as the primary point of contact for enrollment and credentialing inquiries
* Research and resolve provider enrollment issues and escalations
* Facilitate group and individual provider enrollment with commercial and government payers
* Review and process Provider Issue Forms for follow-up and resolution
* Maintain enrollment matrices, SOPs, templates, welcome letters, and related documentation
* Create and distribute provider credentialing and enrollment reports
* Research payer-specific enrollment requirements across multiple states
* Support payer contract implementation and enrollment documentation
* Maintain provider records within Veritystream and other credentialing platforms
* Complete and submit enrollment applications for government and commercial payers
* Monitor enrollment application statuses and identify potential issues
* Track provider license and credential expiration dates
* Maintain provider information in CAQH, PECOS, NPPES, and CMS databases
* Process provider license renewals, DEA renewals, and controlled substance registrations
* Complete government payer revalidation requests
* Coordinate hospital credentialing and re-credentialing activities
* Partner with revenue cycle and billing teams to resolve enrollment-related denials and authorization issues
* Assist with additional department projects and duties as assigned

### Requirements

* High School Diploma or equivalent
* Two years of office experience or related college coursework preferred
* Knowledge of health plan billing and enrollment processes preferred
* Experience with PECOS and CAQH preferred
* Veritystream experience preferred
* Strong attention to detail and organizational skills
* Excellent analytical and problem-solving abilities
* Strong written and verbal communication skills
* Ability to prioritize multiple projects and deadlines
* Proficiency with Microsoft Outlook, Word, Excel, Adobe Acrobat, and Windows-based systems

### Good Fit For

This role may be a strong fit for candidates with experience in provider enrollment, medical credentialing, healthcare administration, medical billing, insurance verification, revenue cycle management, payer relations, healthcare compliance, practice management, or back-office healthcare operations.