Provider Enrollment/Credentialing Specialist

Omega Healthcare Management Services•Boca Raton, FL

About The Position

The Provider Enrollment/Credentialing Specialist at OMH Healthedge Holdings Inc serves as the central liaison among providers, medical staff services, payer organizations, revenue cycle teams, and practice leadership. The role manages provider enrollment, credentialing, and payer-system linkage across the Central and West regions to support accurate billing, timely reimbursement, and compliance with applicable regulations.

Requirements

Bachelor's degree in Health Administration, Business, or a related field, or equivalent experience.
At least 2 years of experience in provider enrollment, credentialing, or payer relations within a hospital or health system.
Strong knowledge of Medicare, Medicaid, and commercial payer enrollment requirements.
Excellent organizational skills and ability to manage multiple applications simultaneously.
Proficiency with enrollment software platforms such as CAQH and PECOS, and Microsoft Office Suite.
Effective communication skills for interacting with providers, payers, and internal teams.
Detail-oriented approach with a focus on regulatory compliance and accuracy.
Ability to analyze enrollment data and produce actionable reports.

Nice To Haves

Experience working in a multi-regional or multi-site health organization.
Certified Provider Enrollment Specialist (CPE) or similar credential.

Responsibilities

Submit and track enrollment applications for physicians, APPs, and eligible practitioners with Medicare, Medicaid, and commercial payers.
Maintain current credentialing files, including licenses, certifications, and privileging documents.
Coordinate with medical staff services to verify provider privileges and resolve discrepancies.
Monitor enrollment status dashboards and proactively address pending or denied applications.
Communicate enrollment requirements and updates to providers and practice leadership.
Collaborate with revenue cycle teams to ensure accurate payer linkage for billing.
Respond to payer inquiries, audits, and re-credentialing requests in a timely manner.
Develop and maintain standard operating procedures and documentation for enrollment processes.
Train and support new providers on enrollment workflows and compliance expectations.
Generate regular reports on enrollment metrics, turnaround times, and compliance status for senior management.