Provider Enrollment Specialist

Job Summary

To clear existing enrollment backlogs and streamline payer application workflows, the part-time contract Provider Enrollment Specialist will manage the end-to-end credentialing process, working directly with Managed Care Organizations (MCOs) and state Medicaid programs while navigating complex payer portals.

Key responsibilities

• Executing initial enrollment applications and re-credentialing packets with commercial and government healthcare payers
• Maintaining and attesting CAQH profiles, NPI data, and Tax Identification Number (TIN) attachments to prevent coverage lapses
• Tracking pending enrollment applications with MCOs and health plans to expedite processing and secure official effective dates

Required qualifications

• One to three years of experience in healthcare provider credentialing, payer enrollment, or managed care onboarding
• High school diploma or GED
• Demonstrated proficiency with payer enrollment portals like Availity, PECOS, and state Medicaid systems
• Deep understanding of payer-specific credentialing rules, state licensing standards, and enrollment timelines
• Strong analytical skills to identify missing documentation and resolve enrollment delays independently