Provider Credentialing & Contracting Specialist
Coordinate provider and location enrollment, maintain credentialing records, and follow up with payers on outstanding requirements before they affect billing.
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Prepare credentialing and re-credentialing submissions, track requirements, and follow up with commercial payers, Medicare (PECOS), and Medicaid.
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Maintain strict accuracy of CAQH profiles and provider rosters to prevent "provider not enrolled" claim edits.
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Track payer contract structures, fee schedules, and linked facility locations to support accurate expected-versus-paid variance reporting.
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Actively manage escalation paths for stalled payer enrollments, directly contacting payer representatives to resolve application exceptions.
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Audit and update internal systems to ensure billing teams have real-time visibility into effective dates and network participation status.
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3+ years of experience in healthcare credentialing, provider enrollment, or payer contracting for multi-specialty groups or facilities.
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Experience using CAQH, PECOS, and navigating complex commercial payer enrollment portals.
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Experience maintaining accurate provider records and resolving payer enrollment issues before they affect billing.
Location: Remote (Strictly limited to MA, FL, CT, PA, Montreal or NC residents)
Schedule: Part-Time (25 hours/week)