Job description
Primary Responsibilities
Own end-to-end provider credentialing and enrollment processes from onboarding through approval and ongoing maintenance, delivering a high-touch, white-glove provider experience
Serve as the primary escalation point for complex credentialing issues, partnering with third-party vendor (Advantum) and insurance payors to drive timely resolution
Manage consistent, professional communication with assigned providers across a portfolio of 50+ practice locations, ensuring alignment and responsiveness
Oversee collection, validation, and ongoing maintenance of provider data and onboarding documentation to ensure accuracy, completeness, and compliance
Maintain end-to-end visibility and accountability for enrollment progress, followups,
and project initiatives through effective ticketing system management and tracking
Ensure integrity, accuracy, and compliance of provider records and databases in
accordance with internal standards and regulatory requirements
Guide providers through credentialing and re-credentialing processes, proactively
addressing inquiries and ensuring timely resolution of outstanding items
Develop and maintain strong relationships with health plans and insurance payor
representatives to support successful enrollment outcomes
Partner cross-functionally with internal stakeholders, including:
o Revenue Cycle Management: Resolve billing issues related to credentialing status and enrollment gaps o Payor Relations: Align on timely execution of payor contracts to support accurate enrollment submissions
Proactively identify, analyze, and resolve enrollment gaps, delays, and risks
impacting practice operations and revenue cycle performance
Ensure strict compliance with all applicable state and federal regulations, including
Medicare and Medicaid requirements
Contribute to team initiatives focused on enrollment cleanup, process
improvement, and operational efficiency
Perform additional credentialing, compliance, and operational support duties as
assigned Minimum Qualifications / Requirements
Minimum of 2 years of direct provider enrollment and credentialing experience
required
2–3 years of administrative experience in a healthcare environment preferred
Working knowledge of Medicare, Medicaid, and commercial payor enrollment
processes
Well versed within CAQH, NPPES, PECOS, and payor portals (e.g., Availity, One
HealthCare ID, etc.)
High School diploma or GED required (Associate’s or Bachelor’s degree preferred)
Strong organizational skills with exceptional attention to detail
Ability to manage multiple priorities, deadlines, and competing demands in a fastpaced
environment
Excellent communication, interpersonal, problem-solving, and critical thinking
skills
Ability to work independently with minimal supervision while maintaining
accountability
Comfortable working in a remote environment with video-based collaboration
Key Competencies
Customer-focused with a high level of professionalism
Strong follow-through and accountability
Adaptability and resourcefulness in problem-solving
Cross-functional collaboration and relationship-building
Process-driven with a focus on accuracy and compliance
Originally posted on Himalayas
Who can apply
Eligible countries: United States. Accepted UTC offsets: UTC-10, UTC-9, UTC-8, UTC-7, UTC-6, UTC-5, UTC+14. Review the full description for employer-specific work authorization, residency and schedule requirements.