Payer Enrollment & Credentialing Specialist - Medicare/Medicaid

AIS Healthcare•Remote,

1d•Remote

About The Position

The Payer Enrollment & Credentialing Specialist supports the end-to-end payer credentialing lifecycle for a national network of home infusion pharmacies, specialty pharmacies, infusion centers, and affiliated clinical providers. The role coordinates credentialing and recredentialing activities, validates provider and organizational data, maintains credentialing records, and ensures required documentation meets payer, regulatory, and accreditation standards. It helps maintain active network participation and prevent service disruptions related to credentialing gaps. The specialist prepares and submits payer enrollment applications, manages Medicare and Medicaid enrollment processes, monitors application progress, and communicates with payer departments and internal stakeholders. The position requires experience completing Medicare and Medicaid credentialing applications and proficiency with credentialing resources and Microsoft Office tools. This is a 100% remote opportunity.

Requirements

Minimum of 3 years of payer credentialing experience, including experience completing Medicare and Medicaid payer credentialing applications.
Experience completing payer credentialing applications through multiple submission methods.
Experience with Medicare and Medicaid payer enrollment processes.
Experience working within home infusion, specialty pharmacy, provider services, or healthcare organizations.
Working knowledge of CAQH, PECOS, NPPES, and NCPDP.
Ability to interpret and use provider taxonomy codes, NPIs, and other provider identifiers.
Experience managing multiple applications simultaneously while meeting deadlines.
Strong organizational skills and attention to detail.
Excellent verbal and written communication skills.
Ability to work independently in a remote environment.
Proficiency with Microsoft Outlook, Word, Excel, and SharePoint.
Completion of the Culture Index Assessment is required before the application will be reviewed.

Nice To Haves

Medicare and Medicaid enrollment and revalidation experience.
Home Infusion experience.
Specialty Pharmacy experience.
Experience navigating contract management software.
Experience supporting provider and organizational credentialing initiatives across multiple states.

Responsibilities

Coordinate payer credentialing and recredentialing activities for specialty pharmacies, infusion centers, and affiliated providers.
Prepare, complete, and submit payer enrollment and credentialing applications accurately and within established deadlines.
Manage Medicare and Medicaid enrollment and revalidation submissions.
Maintain organized records of licenses, accreditations, insurance documents, provider credentials, and enrollment documentation.
Serve as the primary point of contact for payer credentialing departments regarding application statuses, delays, and issue resolution.
Monitor credentialing milestones and maintain accurate records within Salesforce and credentialing databases.
Track application progress and proactively communicate updates to internal stakeholders.
Maintain detailed documentation to satisfy commercial, government, and third-party payer requirements.
Ensure provider information is accurate and consistent across credentialing platforms and payer applications.
Support compliance with regulatory, accreditation, and contractual requirements.
Protect patient privacy and maintain confidentiality in accordance with HIPAA guidelines.
Assist with special projects and additional duties as assigned.