Credentialing Specialist (Payer Enrollment)

Lumexa Imaging

About The Position

The Provider Enrollment Specialist is responsible for enrolling healthcare providers with commercial insurance payers, Medicare, and Medicaid to ensure timely reimbursement for services rendered. This role manages the end-to-end application process, monitors credentialing status, and resolves enrollment-related issues. Success in this role requires strong attention to detail, knowledge of healthcare regulations, and effective communication skills to collaborate with providers and payer representatives.

Requirements

Minimum of 2 years of payer enrollment and provider credentialing experience in a healthcare setting.
Strong understanding of provider credentialing and payer enrollment processes.
CAQH experience is required
Familiarity with provider identifiers, including NPI (National Provider Identifier) and TIN (Tax Identification Number).
Excellent organizational skills with the ability to manage multiple priorities in a fast-paced environment.
Strong verbal and written communication skills.
High level of accuracy and attention to detail.
Ability to build and maintain effective working relationships with providers, internal teams, and external payer contacts.
Proficiency in Microsoft Office applications (Word, Excel, and Access) and credentialing software platforms.

Nice To Haves

Experience with MD Staff or similar credentialing software is preferred.

Responsibilities

Prepare, submit, and track provider enrollment applications, re-credentialing packets, and demographic updates with commercial and government payers in a timely manner.
Proactively communicate with insurance representatives to monitor application status, resolve processing issues, and reduce approval turnaround times.
Accurately maintain and audit provider data within credentialing systems and databases such as CAQH, PECOS, and NPPES.
Work closely with billing, credentialing, and HR teams to ensure alignment and accuracy of provider information across all internal systems and platforms.
Investigate and resolve claim denials, rejections, or payment delays resulting from enrollment discrepancies, provider data issues, or taxonomy errors.