Credentialing & Health Plan Enrollment Specialist

This is a remote position.

Our client is seeking a Credentialing & Health Plan Enrollment Specialist to support provider demographic changes credentialing and health plan enrollment for physicians and ancillary providers within a clinical group practice. This role requires close collaboration with providers practice administrators billing vendors health plans (commercial and governmental) and credentialing vendors to ensure compliance accuracy and efficiency.

The Specialist will be responsible for maintaining credentialing documentation ensuring compliance with healthcare regulations and supporting enrollment processes that enable timely and accurate reimbursement. Success in this role requires strong organizational skills attention to detail and the ability to effectively manage multiple stakeholders.

• Manage the full credentialing lifecycle for healthcare providers including initial credentialing re-credentialing and health plan enrollment
  

• Ensure credentialing documentation is accurate complete and compliant with regulatory standards and payer requirements
  

• Maintain up-to-date knowledge of healthcare regulations accreditation standards and payer policies
  

• Collaborate with internal teams providers and external agencies to resolve credentialing issues and ensure timely processing
  

• Oversee health plan enrollment processes including eligibility verification application submission and status tracking
  

• Support billing and coding teams by aligning credentialing and enrollment data with reimbursement processes
  

• Maintain accurate provider files licenses DEA certificates malpractice coverage and other required documentation
  

• Assist providers with CAQH applications and other enrollment-related requirements
  

• Participate in quality improvement initiatives to streamline credentialing and enrollment operations
  

• Ensure compliance with HIPAA regulations and maintain confidentiality of sensitive data
  

• Bachelor s degree in Healthcare Business Finance or related field OR a minimum of 3 years of equivalent healthcare experience
  

• 3 5 years of proven experience in credentialing and health plan enrollment (Medicare Medicaid commercial insurers and TPAs)
  

• Strong knowledge of healthcare regulations accreditation standards and payer requirements
  

• High attention to detail with strong record-keeping and compliance management skills
  

• Proficiency in Microsoft Office Suite (Excel Word PowerPoint Visio) and online credentialing databases
  

• Excellent written and verbal communication skills; professional interaction with diverse stakeholders
  

• Strong problem-solving decision-making and organizational abilities
  

• Ability to work independently with minimal supervision while contributing to a collaborative team environment
  

• Results-driven and detail-oriented
  

• Strong interpersonal and communication skills
  

• Ability to handle sensitive information with confidentiality
  

• Customer service mindset with a commitment to quality and compliance
  

• Adaptability in a dynamic fast-paced healthcare environment
  

• Standard business hours with occasional extended hours or weekend requirements
  

• Regular use of standard office equipment and virtual collaboration tools
  

• Permanent work-from-home arrangement
  

• Immediate hiring
  

• Commissions and incentives