Licensing and Credentialing Provider Enrollment Specialist

Monogram Health

13h

About The Position

The Licensing & Credentialing Provider Enrollment Specialist role supports Monogram Health’s provider onboarding and full-cycle payer enrollment efforts by ensuring accurate, timely licensing, credentialing, and enrollment with federal, state, and commercial payors. This role requires deep expertise in Medicare enrollment, including Provider Enrollment, Chain, and Ownership System (PECOS), and plays a critical part in accelerating practitioner readiness and patient engagement. The ideal candidate is detail-driven, process-oriented, and adept at balancing onboarding and payer enrollment responsibilities in a fast-paced, growth-oriented environment. Equally important, this role requires maintaining a positive, patient-centered attitude while partnering with newly onboarding practitioners. This position collaborates closely with Licensing & Credentialing, HR, Recruiting, Implementation, Billing, and Clinical teams, demonstrating professionalism, empathy, and positive energy to ensure practitioners feel supported and can engage patients as quickly and efficiently as possible.

Requirements

• Bachelor’s degree or equivalent combination of education and experience
• Minimum of three (3) years of experience in payer enrollment and credentialing within a healthcare organization, MSO, or CVO
• Extensive Medicare enrollment experience, including PECOS
• Working knowledge of Medicaid and commercial payer enrollment
• Proficiency with Microsoft Office (Excel, Outlook, Teams) and ability to learn new systems quickly
• Experience with credentialing, compliance, or provider data systems (e.g., Modio, ProviderTrust, Salesforce, Smartsheet, CAQH)
• Organizational, analytical, and problem-solving skills with proven attention to detail
• Ability to identify discrepancies, resolve issues proactively, and manage multiple time-sensitive deliverables independently
• Effective written and verbal communication skills with providers, leadership, and external agencies
• Demonstrated professionalism, sound judgment, critical thinking, and decision-making abilities
• Comfortable managing high volume and multiple concurrent enrollments
• Clear, professional communicator with practitioners, payors, and internal stakeholders
• Adaptable and proactive in a fast-paced, evolving healthcare environment

Responsibilities

• Manage end-to-end payer enrollment for Medicare, Medicaid, Medicare Advantage, and commercial payors, including individual and group enrollments
• Research and apply payor-specific enrollment protocols, telehealth requirements, and state regulations
• Submit clean, complete enrollment applications and perform consistent follow-up until approval and network participation are confirmed
• Maintain and update practitioner participation across CAQH, PECOS, Availity, Medicaid portals, and other enrollment systems
• Serve as primary point of contact for payor follow-up and issue resolution
• Produce delegated rosters and communicate enrollment status updates to leadership and Client Partnership teams
• Partner with Licensing, Billing, Contracting, Operations, and Clinical teams to support revenue cycle and patient readiness
• Serve as a key onboarding partner for new practitioners, ensuring seamless transition through licensing, credentialing, and payer enrollment processes
• Guide practitioners through completion of demographic intake, credentialing packets, CAQH setup, Medicare (PECOS), CMS I&A, NPPES, and other required systems
• Generate and distribute onboarding and credentialing forms; obtain all required documentation and signatures
• Identify, research, and resolve credentialing discrepancies, missing information, and timing gaps
• Maintain accurate and audit-ready records in credentialing software and shared drives in compliance with NCQA and internal standards
• Understand all critical lifecycle milestones (application receipt, committee review, approvals, effective dates)

Benefits

• Comprehensive Benefits - Medical, dental, and vision insurance, employee assistance program, employer-paid and voluntary life insurance, disability insurance, plus health and flexible spending accounts
• Financial & Retirement Support – Competitive compensation, 401k with employer match, and financial wellness resources
• Time Off & Leave – Paid holidays, flexible vacation time/PSSL, and paid parental leave
• Wellness & Growth – Work life assistance resources, physical wellness perks, mental health support, employee referral program, and BenefitHub for employee discounts

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Number of Employees: 251-500 employees