Provider Credentialing & Enrollment Specialist

PM Pediatric Care

3d • $33 - $36 • Remote

About The Position

This is a part-time, temporary position with the potential to transition into a full-time role. This is a remote position. We are seeking a detail-oriented Credentialing & Enrollment Specialist to support provider enrollment, revalidation, and ongoing maintenance across multiple payors and states. This role focuses on resolving enrollment issues, reducing denials, and ensuring timely provider participation and reimbursement.

Requirements

• Minimum two years in provider credentialing and enrollment, including Medicaid/revalidations/ETIN certifications for NY/NJ states.
• Knowledge of CAQH, Application utilizing our 3rd party vendor platform-Medallion.
• Strong attention to detail and analytical skills.
• Ability to manage multiple priorities in a fast-paced environment.

Nice To Haves

• Experience in behavioral health credentialing and enrollment is a plus.

Responsibilities

• Review and resolve enrollment with focus on state-specific requirements.
• Identify and trend denial patterns to prevent recurrence (e.g., taxonomy mismatches, missing DEA, non-participating providers, admitting privileges).
• Review Medicaid applications, revalidations, and facility enrollments at both group and individual levels.
• Support NY ETIN and ETINS processing as required.
• Prepare and submit monthly rosters and uploads, including new provider additions and terminations.
• Manage delegated rosters such as NY-NJ Fidelis and submissions through 3rd party vendor Medallion platform.
• Track and resolve payors pending over 90 days and identify roadblocks.
• Manage incoming emails and correspondence and confirm appropriate mail types and follow-up actions.
• Support telehealth enrollment workflows and system integrations.
• Assist with administrative tasks, documentation, and audit readiness.
• Ensure requests submitted through 3rd party vendor Medallion are timely and accurate.
• Collaborate with leadership to identify root causes of delays and prevent recurrence.

Benefits

• Compensation Range: $33.00 hr. - 36.00 hr.
• The salary/rate range listed here has been provided to comply with local regulations and represents a potential base salary/rate for this role. Please note that actual salaries/rates may vary within this range above or below, depending on experience and location. We look at compensation for each individual and based on experience and qualifications.

What This Job Offers

• Job Type: Part-time
• Career Level: Mid Level
• Education Level: No Education Listed