Credentialing & Enrollment Specialist

Mainspring Recovery•Pikesville, MD

5d•$70,000 - $80,000•Hybrid

About The Position

Walker Health Services, a medical billing company providing revenue cycle support to healthcare organizations, is seeking an experienced Credentialing & Enrollment Specialist with strong Virginia FFS/MCO experience, preferably within ARTS (Addiction and Recovery Treatment Services). This role is responsible for end-to-end facility and provider enrollment and credentialing, with a primary focus on Virginia Medicaid, including ARTS programs, residential treatment facilities, and ORP providers, and secondary exposure to select commercial payers. Medicaid facility enrollment experience is required and is a core function of this role. The Credentialing & Enrollment Specialist will serve as a key liaison between clients, providers, and payers, ensuring accurate enrollment, timely revalidations, and ongoing compliance with payer, state, and federal requirements.

Requirements

2–5+ years of credentialing and enrollment experience, with direct Virginia Medicaid experience.
Demonstrated experience with facility enrollment and ongoing maintenance (not provider-only credentialing).
Strong knowledge of ORP provider enrollment and maintenance.
Ability to manage revalidations, changes of information, and compliance-driven updates.
High attention to detail, strong organizational skills, and ability to manage multiple enrollments simultaneously.

Nice To Haves

Experience working with ARTS programs, behavioral health, SUD, or residential treatment settings.
Experience with Virginia Medicaid MCOs and select commercial payers.
Established working relationships with DMAS or payer credentialing departments.
Experience supporting multiple clients in a billing or third-party services environment.

Responsibilities

Lead facility-level enrollment, credentialing, revalidation, and maintenance with Virginia Medicaid FFS/MCOs, including ARTS programs and residential treatment facilities.
Manage initial enrollments, revalidations, changes of information, ownership updates, service additions, and terminations.
Coordinate enrollment sequencing between licensure, Medicaid enrollment, and payer credentialing to avoid reimbursement delays.
Enroll, credential, and maintain individual providers, with a strong emphasis on ORP providers, including proper linkage to enrolled facilities.
Manage provider onboarding, offboarding, role changes, and reassignments across Medicaid and commercial payers.
Track and manage provider recredentialing and revalidation cycles to prevent lapses.
Obtain and maintain provider authorizations, attestations, and documentation, including CAQH profiles and payer portals.
Serve as a point of contact for credentialing and enrollment matters.
Monitor application status, follow up with payers, resolve deficiencies, and escalate issues as needed.
Maintain strong working relationships with payer representatives; existing payer relationships are preferred.
Maintain accurate and complete credentialing and enrollment records across Medicaid portals, CAQH, payer systems, and internal tracking tools.
Ensure all records are audit-ready and updated timely.
Review payer directories and enrollment listings to ensure accuracy.
Meet or exceed internal timelines and payer deadlines.