Provider Enrollment & Credentialing Specialist

Description

Job Title: Provider Enrollment & Credentialing Specialist

Also referred to as: Credentialing Specialist, Enrollment Coordinator, Provider Services Coordinator  

Location: Charlotte,  Hybrid, requiring 2 to 3 days in the office 
Job Type: Full-time 

SUMMARY: 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.

Essential duties and Responsibilities

Duties include but are not limited to:

• 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.

Minimum Qualifications

To perform this job successfully an individual must be able to perform each essential duty to a satisfactory standard. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Education: High School Diploma or GED required; associate degree or additional coursework in healthcare administration, business administration, or a related field preferred. 

Experience: 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. 

License/Certification: Certified Provider Credentialing Specialist (CPCS) or Provider Enrollment Specialist Certification (PESC) preferred. 

Communication Skills: Demonstrated ability to exercise professional oral and written communication skills with all internal and external audiences.