Provider Enrollment & Credentialing Specialist

Providence Anesthesiology Associates PA•Charlotte, NC

5d•Hybrid

About The Position

The Provider Enrollment & Credentialing Specialist is responsible for coordinating, preparing, submitting, tracking, and following up on provider credentialing and payor enrollment applications for physicians and advanced practice providers. This role supports enrollment with hospitals and ambulatory surgery centers, commercial insurance companies, government payors, and other applicable organizations where PAA provides patient care. The Provider Enrollment & Credentialing Specialist also maintains accurate provider files and enrollment records, including revalidations, licensure, certifications, and related documentation, to support ongoing compliance with organizational, payor, and regulatory requirements. This position requires integrity, attention to detail, dependability, initiative, and a commitment to embracing company values.

Requirements

High School Diploma or GED required
Demonstrated ability to exercise professional oral and written communication skills with all internal and external audiences.
Proficiency with Microsoft Outlook, Word, and Excel required.
Strong attention to detail, organizational skills, follow-through, and ability to manage multiple deadlines.
Ability to communicate professionally with providers, payors, facilities, and internal teams.
Working knowledge of provider credentialing, payor enrollment processes, compliance requirements, and confidentiality standards.
Ability to identify issues, resolve routine problems, and escalate matters appropriately.

Nice To Haves

associate degree or additional coursework in healthcare administration, business administration, or a related field preferred.
Two years of provider credentialing, payor enrollment, medical staff services, healthcare administration, or related experience preferred.
Experience working with insurance carriers, Medicare, Medicaid, CAQH, PECOS, NPPES, and credentialing or enrollment systems is preferred.
Certified Provider Credentialing Specialist (CPCS) or Provider Enrollment Specialist Certification (PESC) preferred.
Experience with credentialing software, payor portals, CAQH, PECOS, NPPES, and other enrollment platforms preferred.

Responsibilities

Prepare, submit, and monitor payor enrollment applications for physicians and advanced practice providers with commercial insurance carriers, Medicare, Medicaid, and other applicable payors.
Coordinate initial enrollment, re-enrollment, reappointments, demographic updates, terminations, and maintenance of provider participation records with insurance companies and payor portals.
Complete and maintain electronic physician credentialing files, including licensure, board certification, DEA registrations, malpractice coverage, work history, education, training, references, and other required documentation.
Track application status, follow up with payors, facilities, providers, and internal departments, and provide timely updates regarding pending enrollment and credentialing matters.
Monitor credentialing and enrollment deadlines to ensure timely renewals, reappointments, revalidations, and compliance with payor and facility requirements.
Review provider profiles and enrollment records to identify discrepancies, missing information, or potential issues; initiate corrective action and escalate concerns as appropriate.
Coordinate with physicians, advanced practice providers, managers, billing staff, and administrative teams to obtain signatures, documentation, and information required for credentialing and payor enrollment.
Maintain accurate and organized credentialing and enrollment records in applicable databases, credentialing software, spreadsheets, and provider files.
Support compliance monitoring by ensuring provider files meet internal standards, payor requirements, facility standards, HIPAA requirements, and applicable regulatory guidelines.
Respond to internal and external inquiries related to provider enrollment, credentialing status, documentation requests, and routine payor or facility matters.
Prepare reports, status updates, and tracking logs related to credentialing, payor enrollment, expirable, and compliance activity.
Maintain confidentiality of provider and organizational information and ensure compliance with all Health Insurance Portability and Accountability Act (HIPAA) standards.
Perform other duties as assigned within the scope of responsibility.