Credentialing And Enrollment Specialist

Description

The Credentialing and Enrollment Specialist is responsible for the end-to-end management of insurance enrollment for practices and providers. This role ensures timely submission and approval of applications and associated documentation with insurance carriers and plans. The specialist proactively manages the initial application and renewal cycle, maintains up-to-date credentialing data in CAQH and other collection portals, and serves as a key point of contact for medical providers and practice stakeholders. By coordinating data gathering and communicating progress regularly, this individual ensures smooth operational readiness and network participation.

This is a fully remote, part time position (10 hours per week with flexible scheduling on weekday mornings or early afternoons).

Essential Functions / Tasks / Duties / Responsibilities:

• Manage the full lifecycle of provider and practice enrollment with insurance carriers and health plans, from initial submission through final approval.
• Monitor application status and proactively manage renewals to ensure no lapses in coverage, specifically tracking and initiating renewals at least 60 days prior to expiration.
• Maintain accurate and current practitioner data in CAQH and other relevant credentialing and data collection websites.
• Coordinate directly with medical providers to collect, verify, and organize necessary documentation for application forms.
• Facilitate regular meetings with practice stakeholders to provide status updates, performance reporting, and clear communication on overall enrollment progress.
• Proactively communicate updates, issues, and approval timelines to both providers and internal leadership.
• Troubleshoot enrollment hurdles and resolve issues that may hinder timely participation.
• Assist billing teams internally and externally with claims denials related to provider enrollment status.
• Perform other duties as assigned.

Requirements

Competencies

• Exceptional attention to detail and ability to track complex, long-term administrative workflows.
• Strong verbal and written communication skills, with the ability to lead effective meetings with practice stakeholders.
• Ability to work independently and manage time effectively to meet 60-day renewal deadlines.
• Proficiency in maintaining accurate data in CAQH, insurance portals, and internal documentation systems.
• Strong interpersonal skills for collaborating with medical providers and team leadership.

Education / Professional Certifications or Licenses Required:

• Diploma or GED required
• Certification through applicable organization a plus

Experience Requirements:

• Two (2) or more years of experience in healthcare enrollment, credentialing, or medical practice operations.
• Demonstrated experience with CAQH and insurance carrier portals.
• Experience in a role requiring high-volume data collection and stakeholder communication.

Work Environment / Physical demands/ Travel Requirements:

• Ability to utilize communication tools including computer and telephone.
• Significant amount of sitting and standing on a daily basis

Core Values:

Office Practicum seeks to hire individuals who are able and willing to embrace our company's performance based culture, as defined by our Core Values:

• We are Clinician First
• Pediatric Care is our Home
• We Deliver on our Commitments
• Our Success is Based on Results
• We Believe in the Power of Teams

We believe that consistently aligning our planning and execution with these core values will lead to long term success for both Office Practicum as well as the customers we serve.

Equal Employment Opportunity Statement:

Our company is committed to equal employment opportunity. We will not discriminate against employees or applicants for employment on any legally recognized basis ["protected class"] including, but not limited to: veteran status, uniform service member status, race, color, ancestry, pregnancy, childbirth and related medical conditions, national origin, non-job related handicap or disability, or the use of a guide or support animal, creed, religion, sex, sexual orientation, national origin, age [18 and over] - [40 or over], physical or mental disability, predisposing genetic characteristics, military status, marital status, protected action, concerted activity, or any other protected class under federal, state or local law.

Americans with Disabilities Act Statement:

Our company is committed to providing equal employment opportunities to otherwise qualified individuals with disabilities, which may include providing reasonable accommodation where appropriate. In general, it is your responsibility to notify your supervisor of the need for accommodation. Upon doing so, your supervisor may ask you for your input or the type of accommodation you believe may be necessary or the functional limitations caused by your disability. Also, when appropriate, we may need your permission to obtain additional information from your physician or other medical or rehabilitation professionals.