About this role

Supports 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
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
Enters tracking and conducts timely follow-up
Supports strategic partners and internal counterparts to answer inquiries and provides enrollment and credentialing updates
Serves as subject-matter-expert for providers with onboarding instructions and support
Collaborates with various revenue cycle departments to obtain innovative initiatives to achieve optimal results

1 to 3 Years of 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