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Provider Enrollment, Credentialing Specialist
Medic Management GroupCredentialing Specialist responsible for managing healthcare provider credentialing and enrollment processing. Ensures accuracy and compliance in documentation for providers working with Medicare, Medicaid, and commercial insurances.
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in credentialing processes, including provider enrollment with Medicare, Medicaid, and commercial insurances, while maintaining compliance with HIPAA standards. Proficient in data management and communication, ensuring timely and accurate handling of credentialing applications and provider information.
Highest-signal resume keywords
Credentialing ExperienceProvider Enrollment ProcessesKnowledge of Availity and PECOSProficiency in MS OfficeDetail Orientation
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
CredentialingData EntryApplication CompletionDocument ReviewProvider VerificationNPI MaintenanceBilling KnowledgeMulti-taskingProblem SolvingDecision Making
Soft Skills
Interpersonal SkillsCommunicationTeam PlayerTime ManagementOrganization
Tools & Technologies
CAQHAvailityPECOSMS Office
Industry Keywords
Health Care ProvidersMedicareMedicaidCommercial InsurancesFQHCBehavioral HealthHIPAA Compliance
About the role
Key responsibilities & impact- Credentialing new and established health care providers
- Maintenance of information including application completion, follow up, data collection, data entry, and document review
- Establish and maintain data entry in CAQH
- Prepare credentialing applications for all initial applications and reappointments in a timely and complete manner
- Verify provider and group information with insurance companies
- Coordinate information for enrollment and terminations of all providers
- Maintain good rapport and professional communication with Health Plan Representatives
- Handle enrollment with Medicare, Medicaid, and commercial insurances in multiple states
- Build strong working relationships with medical facilities and provider offices
- Adhere to department policies and procedures including timely delivery of completed work and use of resources
- Responsible for entering, updating, maintaining NPI and any other applicable provider numbers
- Provide concise, timely communication to appropriate leadership regarding potential credentialing issues
- Proactively share knowledge with colleagues
- Perform analysis and appropriate follow-up of each initial application and reappointment
- Work with physicians, professional staff and physician's office staff to acquire necessary materials and information
Requirements
What you’ll need- High school diploma or equivalent
- Minimum 3 years of credentialing experience
- Billing knowledge and experience preferred
- Prior experience with FQHC and Behavioral Health necessary
- Current knowledge of provider enrollment processes with Medicare, Medicaid, and commercial insurances
- Working knowledge of Availity, PECOS, etc. is required
- Proficiency in MS Office, primarily Word, Outlook, Excel
- Excellent interpersonal skills to communicate with medical staff, providers and clients
- Detail orientation
- Ability to abide by HIPPA standards and requirements
- Ability to multi-task
- Ability to work as a team player
- Ability to handle confidential information in a professional manner
- Willingness to take on new tasks and responsibilities
- Capable of taking the initiative to accomplish tasks
- Strong time management and organization skills
- Excellent problem solving and decision-making abilities
Benefits
Comp & perks- 🌐 Worldwide ❌ Jobs You've Hidden ⭐️ Saved Jobs ✅ Applied Jobs ✉️ Email Alerts 👤 Account Medic Management Group Website LinkedIn All Job Openings 51 - 200 employees 🏥 Healthcare 💼 Consulting 🤝 B2B Healthcare
- Consulting
- B2B Medic Management Group is a company whose name indicates it provides management, administrative, or advisory services related to medical or healthcare operations. Public information supplied was limited (LinkedIn cookie/login content only), so this description is deliberately cautious: based on the name it likely supports healthcare providers, facilities, or programs with management, operational support, billing/administrative services, or consultancy rather than being a direct-care provider. Further public details would be needed to specify exact services or business model. Provider Enrollment, Credentialing Specialist Job not on LinkedIn 🔥 46 minutes ago 🏈 Ohio – Remote 💵 $19 - $23 / hour ⏰ Full Time 🟡 Mid-level 🟠 Senior ✨ Provider Enrollment Specialist Apply Now Find Hiring Managers Customize resume + cover letter Report problem ☆ Save ☑️ Mark as applied ❌ Hide 📋 Description
- Credentialing new and established health care providers
- Maintenance of information including application completion, follow up, data collection, data entry, and document review
- Establish and maintain data entry in CAQH
- Prepare credentialing applications for all initial applications and reappointments in a timely and complete manner
- Verify provider and group information with insurance companies
- Coordinate information for enrollment and terminations of all providers
- Maintain good rapport and professional communication with Health Plan Representatives
- Handle enrollment with Medicare, Medicaid, and commercial insurances in multiple states
- Build strong working relationships with medical facilities and provider offices
- Adhere to department policies and procedures including timely delivery of completed work and use of resources
- Responsible for entering, updating, maintaining NPI and any other applicable provider numbers
- Provide concise, timely communication to appropriate leadership regarding potential credentialing issues
- Proactively share knowledge with colleagues
- Perform analysis and appropriate follow-up of each initial application and reappointment
- Work with physicians, professional staff and physician's office staff to acquire necessary materials and information 🎯 Requirements
- High school diploma or equivalent
- Minimum 3 years of credentialing experience
- Billing knowledge and experience preferred
- Prior experience with FQHC and Behavioral Health necessary
- Current knowledge of provider enrollment processes with Medicare, Medicaid, and commercial insurances
- Working knowledge of Availity, PECOS, etc. is required
- Proficiency in MS Office, primarily Word, Outlook, Excel
- Excellent interpersonal skills to communicate with medical staff, providers and clients
- Detail orientation
- Ability to abide by HIPPA standards and requirements
- Ability to multi-task
- Ability to work as a team player
- Ability to handle confidential information in a professional manner
- Willingness to take on new tasks and responsibilities
- Capable of taking the initiative to accomplish tasks
- Strong time management and organization skills
- Excellent problem solving and decision-making abilities Apply Now 📊 Check your resume score for this job Improve your chances of getting an interview by checking your resume score before you apply. Check Resume Score Similar Jobs Enrollment Specialist – Managed Care Provider Enrollment 🔥 13 hours ago Beth Israel Lahey Health 10,000+ employees 🏥 Healthcare ⚕️ Healthcare Insurance Website LinkedIn All Job Openings Enrollment Specialist focusing on government payer enrollment processes for individual providers and groups. Responsible for timely submissions and maintenance of enrollment documentation. 🇺🇸 United States – Remote 💵 $21 - $32 / hour ⏰ Full Time 🟢 Junior 🟡 Mid-level ✨ Provider Enrollment Specialist Provider Enrollment Specialist 🕒 3 days ago Baptist Health System KY & IN 10,000+ employees 🏥 Healthcare ⚕️ Healthcare Insurance Website LinkedIn All Job Openings Provider Enrollment Specialist coordinating timely and accurate insurance enrollment for employed and contracted providers. Ensuring compliance and effective communication with providers and payors. 🇺🇸 United States – Remote ⏰ Full Time 🟢 Junior 🟡 Mid-level ✨ Provider Enrollment Specialist 🚫👨🎓 No degree required Provider Enrollment Specialist 🕒 3 days ago Baptist Health System KY & IN 10,000+ employees 🏥 Healthcare ⚕️ Healthcare Insurance Website LinkedIn All Job Openings Provider Enrollment Specialist managing enrollment for healthcare providers with insurance carriers. Requires detail-oriented approach and strong communication skills in a remote environment. 🇺🇸 United States – Remote ⏰ Full Time 🟢 Junior 🟡 Mid-level ✨ Provider Enrollment Specialist 🚫👨🎓 No degree required Provider Enrollment Specialist 🕒 6 days ago ASPEN DENTAL GROUP, PC 1 - 10 🏥 Healthcare ⚕️ Healthcare Insurance Website LinkedIn All Job Openings Provider Enrollment Specialist managing enrollment and credentialing processes for Aspen Dental providers. Ensuring accurate submissions and maintaining relationships with insurance payers and dental plans. 🇺🇸 United States – Remote 💵 $24 - $26 / hour ⏰ Full Time 🟡 Mid-level 🟠 Senior ✨ Provider Enrollment Specialist Provider Enrollment Specialist 🕒 July 20 Denver Health 5001 - 10000 🏥 Healthcare ⚕️ Healthcare Insurance 🤝 Non-profit Website LinkedIn All Job Openings Provider Enrollment Specialist coordinating Medicare and Medicaid enrollments for medical staff at Denver Health. Ensuring compliance with regulatory agencies and maintaining relations with providers. 🇺🇸 United States – Remote 💵 $24 - $34 / hour ⏰ Full Time 🟡 Mid-level 🟠 Senior ✨ Provider Enrollment Specialist 🦅 H1B Visa Sponsor 🌐 Worldwide Built by Lior Neu-ner. I'd love to hear your feedback — Get in touch via DM or support@remoterocketship.com Search Search Jobs by country Search jobs by city Search jobs by job title Search entry-level jobs Search junior-level jobs Search senior-level jobs Search jobs by tech stack Search jobs by contract type Search remote internships Search remote part-time jobs Remote jobs Anywhere in the World Companies Hiring Anywhere in the World Companies Hiring Sales People Anywhere in the World Companies Hiring Software Engineers Anywhere in the World Resources Advice Tips for finding remote jobs Interview questions and answers Resume examples Cover letter examples Post a job Affiliates Is Remote Rocketship legit? Privacy policy Terms of service Job board SEO course Remote Job Search MasterClass AI Apply Copilot OpenClaw job finder Find jobs using your resume Jobs by Country Remote jobs anywhere in the world (Worldwide remote jobs) Remote jobs United States Remote jobs Australia Remote jobs Brazil Remote jobs Canada Remote jobs France Remote jobs Ireland Remote jobs Germany Remote jobs Netherlands Remote jobs Spain Remote jobs UK Popular Jobs Remote data analyst jobs Remote customer support jobs Remote executive assistant jobs Remote marketing jobs Remote product designer jobs Remote product manager jobs Remote project manager jobs Remote recruiter jobs Remote sales jobs Remote software engineer jobs Jobs by Type Remote full-time jobs Remote part-time jobs Remote contract jobs Remote internship jobs Remote entry-level jobs Remote jobs with no experience required Remote junior jobs (1-3 years of experience) Digital nomad jobs Remote jobs with no degree required Freelance remote jobs Temporary remote jobs Remote jobs hiring now Stay at home mom jobs