Credentialing and Enrollment Specialist

Office Practicum•Fort Washington, PA

20h•$30 - $35•Remote

About The Position

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.

Requirements

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.
Diploma or GED required
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.

Nice To Haves

Certification through applicable organization a plus

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.