Payor Credentialing Specialist

Eating Recovery Center•Aspen, CO

4h•$21 - $29•Remote

About The Position

The Payor Credentialing Specialist performs duties associated with payor enrollment, credentialing, re-credentialing, and privileging for network providers. This position coordinates credentialing and enrollment for physicians, advanced practice providers, and allied health professionals, working with payors and internal teams to support timely provider participation and reimbursement. The role maintains accurate provider records, tracks credentialing status and expiration dates, supports audits, and ensures compliance with applicable regulations, accreditation standards, HIPAA, and organizational policies. The position is posted as remote. Under company policy, candidates residing within a 35-mile radius of ZIP code 80230 must work a hybrid schedule with three days per week onsite. The expected schedule is Monday through Friday, eight hours per day. Availability during Central Time business hours is preferred; candidates in other U.S. time zones may be considered if they can support the required schedule.

Requirements

High school diploma or GED.
Strong organizational skills, attention to detail, and ability to multitask and prioritize.
Ability to communicate professionally, both verbally and in writing.
At least 3 years of experience in healthcare facility credentialing and physician credentialing.

Nice To Haves

Bachelor’s degree in business, healthcare, or a related field; equivalent years of experience in addition to the minimum requirement may be substituted for the degree.
Certified Provider Credentialing Specialist (CPCS) or Certified Provider Enrollment Specialist (CPES) certification from the National Association of Medical Staff Services (NAMSS).
Experience using MD Staff Software.

Responsibilities

Coordinate credentialing, re-credentialing, and provider enrollment for physicians, advanced practice providers, and allied health professionals.
Complete, review, and submit credentialing and enrollment applications to Medicare, Medicaid, commercial insurance carriers, and managed care organizations.
Monitor application status, follow up with payors, and resolve deficiencies to support timely provider enrollment.
Verify provider credentials, including licensure, education, training, certifications, work history, malpractice coverage, and other required documentation.
Maintain provider records in credentialing databases, including MD Staff, CAQH, PECOS, and NPPES, and track credential expiration dates while maintaining audit-ready files.
Coordinate with providers and internal departments to obtain required documentation and respond to payor requests for additional information.
Research and resolve credentialing and enrollment issues affecting provider participation and reimbursement.
Generate credentialing reports, maintain enrollment status reports, and support internal and external audits.
Ensure compliance with federal and state regulations, accreditation standards, HIPAA, and organizational policies.
Communicate credentialing status updates to leadership and providers.
Participate in process improvement initiatives.