Senior Provider Enrollment & Credentialing Specialist

HealthOp Solutions

4d•Remote

About The Position

This is a senior-level provider enrollment and credentialing role for someone who already knows the work, understands the provider-side process, and can step into a high-accountability environment with confidence. The ideal candidate will be comfortable managing credentialing and enrollment activities from start to finish for provider organizations, clinics, medical groups, and consulting clients. In this role, you will handle provider enrollment workflows, credentialing files, payer applications, revalidations, updates, follow-ups, documentation, and client communication with a high degree of accuracy. You will be expected to prioritize competing deadlines, manage volume without sacrificing precision, and keep enrollment activity moving forward across multiple clients and payers. This is not a training role. The firm is looking for someone who can hit the ground running, operate independently, ask smart questions when needed, and bring a strategic approach to problem-solving. At the same time, this is a strong opportunity for an experienced credentialing and enrollment professional who wants to keep growing. With 27+ years in business and a national client base, the organization offers meaningful exposure to complex provider enrollment work and long-term advancement potential.

Requirements

Significant hands-on experience in provider enrollment and credentialing
Must have experience working directly with provider organizations, clinics, medical groups, or consulting clients
Must understand the provider-side enrollment and credentialing process, not only payer-side credentialing operations
Ability to independently manage enrollment and credentialing workflows from start to finish
Experience with payer applications, payer portals, CAQH, PECOS/NPPES, revalidations, demographic updates, and follow-up processes as applicable
Strong written and verbal communication skills with the ability to interact professionally with clients, providers, payers, and leadership
Excellent organization, prioritization, documentation, and follow-through skills
Ability to work remotely with a high level of accountability, confidentiality, and independence
Must be able to work full-time on a flexible schedule, with options such as 4x10s or 5x8s
5+ Years Provider Enrollment & Credentialing Experience (Commercial, Medicaid, Medicare)
Experience with CAQH, payer portals, and common enrollment workflows
Experience supporting provider credentialing and enrollment from the provider, clinic, healthcare organization, or consulting side; experience limited solely to payer-side credentialing will not meet this requirement.
Comfortable managing multiple providers, groups, and multi-state enrollments simultaneously

Nice To Haves

Experience in a consulting, outsourced credentialing, provider enrollment firm, medical group, MSO, or multi-specialty provider organization
Experience managing multiple clients, provider groups, or payer relationships at one time
Strong knowledge of commercial payer, Medicare, Medicaid, and government enrollment workflows
Experience resolving enrollment delays, payer discrepancies, application issues, and provider data problems
Familiarity with credentialing documentation, licensing, malpractice coverage, board certifications, NPIs, taxonomy, W-9s, EFT/ERA forms, and supporting enrollment materials
Existing provider organization relationships, referral sources, or book of business a plus

Responsibilities

Manage provider enrollment and credentialing activities for provider organizations, clinics, medical groups, and consulting clients
Prepare, review, submit, and track payer enrollment applications, credentialing files, revalidations, updates, and related documentation
Work with commercial payers, government payers, payer portals, CAQH, PECOS/NPPES, and other enrollment tools as applicable
Maintain accurate provider data, enrollment status updates, supporting documents, and credentialing records
Communicate directly with clients, providers, payers, and internal leadership regarding enrollment status, missing information, deadlines, and next steps
Monitor application progress, follow up with payers, resolve delays, and escalate issues when needed
Review provider files for completeness, accuracy, compliance, and readiness prior to submission
Manage multiple client priorities while maintaining strong documentation standards and clear communication
Support credentialing, recredentialing, payer enrollment, demographic updates, terminations, and maintenance workflows
Identify process gaps, payer-specific issues, and opportunities to improve turnaround times or client outcomes
Maintain confidentiality and follow HIPAA, payer, and client-specific documentation expectations
Represent the firm professionally in all client and payer interactions