Credentialing/Payor Enrollment Specialist - Remote

Overview

In this crucial role, you will lead the payor enrollment process, working closely with our Payor Contracting & Credentialing Manager. You'll be a key contributor to our clinical onboarding and ongoing enrollment, ensuring that all clinical providers are efficiently enrolled and renewed with health plans. We’re seeking someone who thrives in a fast-paced environment, has an eye for process improvement, and is eager to explore innovative solutions—whether it's enhancing efficiency or leveraging new tools. The ideal candidate should be passionate about healthcare access.

In Short

• Compile and maintain current and accurate data for all clinical providers.
• Manage credentialing documentation within databases, ensuring timely enrollment and re-credentialing.
• Perform primary source verification during initial credentialing and re-credentialing.
• Partner with HR to ensure new providers are fully enrolled in health plans before their start date.
• Assist new hires with Medicaid and Medicare applications.
• Collaborate with vendors to support payor enrollment processes.
• Research new payor enrollment opportunities to enhance network participation.
• Drive process and tool improvements to adapt to the organization’s growth.
• Identify areas for increased efficiency, including potential outsourcing.
• Strong knowledge of Medicaid, Medicare, and private payer insurance systems.

Requirements

• Minimum of three years of relevant credentialing/payor enrollment experience required.
• Highly organized with the ability to multitask and manage competing priorities effectively.
• Skilled at working under pressure in a fast-paced environment.
• Strong tools/automation orientation.
• Certification by NAMSS as CPMSM or CPCS is preferred.

Benefits

• Comprehensive health, dental, and vision coverage.
• Generous paid time off, including parental leave.
• Fully remote, work from home position; all equipment provided!