Job Overview
Location: Remote (Preference given to candidates who reside in or near Johnson City, TN)
We are seeking an organized, detail-oriented Provider Enrollment & Credentialing Specialist to support our growing healthcare organization. This position is ideal for someone with experience in provider credentialing and payer enrollment who enjoys working independently and managing multiple projects.
This is a remote, as-needed position with flexible hours. Workload will vary based on provider onboarding and credentialing needs, so hours are not guaranteed each week.
Duties
• Manage provider enrollments, revalidations, and recredentialing with Medicare, Medicaid, and commercial insurance plans.
• Prepare and submit enrollment applications and track them through completion.
• Maintain and attest provider CAQH profiles.
• Conduct primary source verifications in accordance with NCQA and payer requirements.
• Verify provider licenses, certifications, DEA registrations, malpractice coverage, and other required credentials.
• Research and resolve provider enrollment, billing, and claims issues with insurance companies.
• Maintain accurate provider records across payer portals and internal systems.
• Communicate with providers, payers, and internal staff to obtain documentation and resolve issues.
Qualifications
• At least 3 years of provider credentialing and enrollment experience.
• Experience with Medicare, Medicaid, and commercial payer enrollments.
• Working knowledge of CAQH and payer enrollment portals.
• Experience conducting primary source verifications.
• Strong organizational, communication, and problem-solving skills.
• Ability to work independently and manage multiple deadlines.
• Excellent organizational skills with meticulous attention to detail to ensure accuracy in documentation and compliance.
• Effective communication skills to liaise with providers, insurance companies, and internal departments professionally.
• Ability to manage multiple priorities efficiently within a fast-paced healthcare environment.
• Relevant certifications are a plus.
Join our team as we streamline provider onboarding processes to support exceptional patient care through precise credentialing practices!
Pay: $20.00 - $29.65 per hour
Application Question(s):
• Do you have experience maintaining and attesting provider CAQH profiles?
• Do you have experience conducting primary source verifications (PSVs) in accordance with NCQA or payer credentialing requirements?
• Have you independently completed provider enrollments with commercial insurance payers (such as BCBS, UHC, Aetna, Cigna, or Humana)?
• This is a remote position with flexible, as-needed hours that vary based on workload rather than a guaranteed weekly schedule. Are you comfortable with this type of work arrangement?
Experience:
• Credentialing and Provider Enrollment: 2 years (Required)
Work Location: Remote