Provider Enrollment & Credentialing Specialist

PedIM Healthcare•Crystal River, FL

13d•Remote

About The Position

PedIM Healthcare is seeking an experienced Provider Enrollment & Credentialing Specialist to support our growing organization. This role is responsible for managing complex provider credentialing and payer enrollment processes across multiple entities, locations, and states. This is a high-impact role requiring prior experience and the ability to work independently in a fast-paced, multi-entity healthcare environment.

Requirements

Minimum 2+ years of credentialing and enrollment experience in a healthcare setting
Strong knowledge of payer enrollment processes and CAQH
Experience working with Medicare, Medicaid, and commercial insurance plans
Ability to manage high-volume, detail-oriented work independently
Strong organizational and follow-up skills
Excellent communication skills

Nice To Haves

Experience with multi-entity or multi-location healthcare organizations
Familiarity with Florida Medicaid and out-of-state enrollments
Experience in primary care, outpatient, or multi-specialty settings

Responsibilities

Manage the full lifecycle of provider credentialing and payer enrollment, including initial applications, revalidations, and ongoing maintenance.
Support multiple tax IDs, provider types, and payer relationships, ensuring accuracy, compliance, and timely processing.
Manage end-to-end credentialing and enrollment for providers with Medicare, Medicaid, and commercial payers.
Complete and maintain CAQH profiles, applications, and revalidations.
Coordinate multi-state and multi-location enrollments across multiple tax IDs.
Track application status and proactively follow up with payers to ensure timely approvals.
Maintain accurate and up-to-date provider records and credentialing files.
Ensure compliance with CMS guidelines and regulatory requirements.
Collaborate with internal teams including HR, operations, and billing.
Identify and resolve enrollment issues that may impact provider billing or revenue.