Credentialing and Provider Enrollment Specialist
TypePart-time job
LocationUnited States
Posted2 hours ago
This is a remote position.
Job Summary
RCM Staff BPO is hiring a part-time Credentialing and Provider Enrollment Specialist to support an orthopedic spine surgery practice based in Georgia.The specialist will manage provider and group enrollment with Medicare, Medicaid, and commercial payers, maintain CAQH profiles, and track every application through approval. This role requires hands-on Medicare enrollment experience through PECOS, strong attention to detail, consistent follow-up, and experience working with U.S. health insurance plans.Key Responsibilities
Prepare, submit, and track Medicare enrollment applications through PECOS, including individual, group, and reassignment of benefits applications
Respond to Medicare Administrative Contractor development requests and correct application issues to keep enrollments moving
Complete Medicaid and commercial payer credentialing and contracting applications for new and existing practice locations
Create, update, and re-attest CAQH ProView profiles using provider-authorized access
Maintain NPI, license, DEA, board certification, malpractice, and hospital privilege records with expiration dates
Follow up with payers by phone, email, and portal until each application is approved and effective dates are confirmed
Track application status, reference numbers, and effective dates in the practice's credentialing tracker
Notify the practice of approvals, denials, missing documents, and upcoming revalidation or re-credentialing deadlines
Process demographic updates such as new locations, address changes, and added services with each payer
Protect patient and provider information and follow HIPAA requirements
Qualifications
At least 2 years of experience with U.S. healthcare credentialing and provider enrollment
Hands-on experience submitting and managing Medicare applications in PECOS, including CMS-855 enrollment and reassignment
Familiarity with commercial insurance and government health plans
Experience with CAQH ProView, NPPES, and payer enrollment portals
Strong written and spoken English
Excellent attention to detail and follow-up skills
Ability to work independently and manage multiple applications and deadlines
Reliable internet connection and a suitable remote workspace
Preferred Qualifications
Experience credentialing surgeons or specialty practices such as orthopedics, spine, or pain management
Experience enrolling a newly formed group practice, including multiple locations
Familiarity with Georgia Medicaid and Georgia commercial insurance plans
Experience with hospital and ambulatory surgery center privileging
Schedule
Part-time position
Must be available during Eastern Time business hours
Final schedule will be determined based on practice needs
Work Arrangement
Remote
Philippines-based applicants preferred
Originally posted on Himalayas
Job Summary
RCM Staff BPO is hiring a part-time Credentialing and Provider Enrollment Specialist to support an orthopedic spine surgery practice based in Georgia.The specialist will manage provider and group enrollment with Medicare, Medicaid, and commercial payers, maintain CAQH profiles, and track every application through approval. This role requires hands-on Medicare enrollment experience through PECOS, strong attention to detail, consistent follow-up, and experience working with U.S. health insurance plans.Key Responsibilities
Prepare, submit, and track Medicare enrollment applications through PECOS, including individual, group, and reassignment of benefits applications
Respond to Medicare Administrative Contractor development requests and correct application issues to keep enrollments moving
Complete Medicaid and commercial payer credentialing and contracting applications for new and existing practice locations
Create, update, and re-attest CAQH ProView profiles using provider-authorized access
Maintain NPI, license, DEA, board certification, malpractice, and hospital privilege records with expiration dates
Follow up with payers by phone, email, and portal until each application is approved and effective dates are confirmed
Track application status, reference numbers, and effective dates in the practice's credentialing tracker
Notify the practice of approvals, denials, missing documents, and upcoming revalidation or re-credentialing deadlines
Process demographic updates such as new locations, address changes, and added services with each payer
Protect patient and provider information and follow HIPAA requirements
Qualifications
At least 2 years of experience with U.S. healthcare credentialing and provider enrollment
Hands-on experience submitting and managing Medicare applications in PECOS, including CMS-855 enrollment and reassignment
Familiarity with commercial insurance and government health plans
Experience with CAQH ProView, NPPES, and payer enrollment portals
Strong written and spoken English
Excellent attention to detail and follow-up skills
Ability to work independently and manage multiple applications and deadlines
Reliable internet connection and a suitable remote workspace
Preferred Qualifications
Experience credentialing surgeons or specialty practices such as orthopedics, spine, or pain management
Experience enrolling a newly formed group practice, including multiple locations
Familiarity with Georgia Medicaid and Georgia commercial insurance plans
Experience with hospital and ambulatory surgery center privileging
Schedule
Part-time position
Must be available during Eastern Time business hours
Final schedule will be determined based on practice needs
Work Arrangement
Remote
Philippines-based applicants preferred
Originally posted on Himalayas
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