Senior Credentialing & Enrollment Specialist

Forge Health•White Plains, NY

About The Position

The Senior Credentialing & Enrollment Specialist is responsible for managing the enrollment and credentialing process for all providers and facilities with government and commercial payors. This role ensures accurate and timely collection, verification, and submission of applications, tracks enrollment status, maintains provider data, and actively resolves credentialing or contracting issues to support uninterrupted billing and compliance operations.

Requirements

Minimum 5-7 years of experience in healthcare payor enrollment and credentialing.
Deep understanding of commercial and government payor enrollment processes and requirements.
Proficiency in EMR/Practice Management systems and CAQH ProView.
Excellent attention to detail, organizational skills, and follow-through.
Strong written and verbal communication with ability to interact professionally with providers and insurance representatives.

Nice To Haves

Certified Provider Credentialing Specialist (CPCS), or similar certification, is a plus.

Responsibilities

Prepare, submit, and track initial and recredentialing applications with Medicaid, Medicare, and commercial insurance payors.
Collect and verify providers’ qualifications and documentation to ensure standards are met.
Maintain accurate provider records including NPI, CAQH, licensure, DEA, and malpractice documentation.
Monitor enrollment timelines and proactively follow up with payors to ensure timely approval.
Collaborate with internal teams (billing, operations, compliance, HR) to ensure provider setup aligns with system and contractual requirements.
Update EMR and RCM systems with credentialing and enrollment data to support billing readiness.
Communicate enrollment status updates to leadership, regional teams, and providers.
Research and resolve payor issues, enrollment denials, or discrepancies in provider information.
Maintain compliance with federal, state, and payor-specific credentialing regulations.
Support audits by providing documentation related to provider enrollment and credentialing records.

Benefits

Competitive salary aligned with your experience
Comprehensive paid time off package
Annual time off to volunteer
Parental leave
Annual continuing education allocations
Competitive medical, dental, and vision package
Annual subscription to a leading meditation app
An environment that fosters professional development including financing for advanced licensure and certifications
Internal supervision opportunities
Dedicated, motivated team and chance to be part of a highly ambitious medical startup
Modern, elegant, and high-end work environment