Payer Enrollment & Credentialing Specialist

Job Title: Payer Enrollment & Credentialing Specialist
Position Type: Full-Time
Work Hours: 9:00 AM – 6:00 PM PDT

Work Days: Monday to Friday
Salary: $5–$6 per hour, depending on experience
Workplace: Remote
Job Overview

Our client is seeking an experienced and detail-oriented Payer Enrollment & Credentialing Specialist to support a healthcare organization with provider credentialing, payer enrollment, re-credentialing, and ongoing provider compliance.

This role will primarily focus on ensuring healthcare providers are properly credentialed and successfully enrolled with insurance payers . You will be responsible for preparing and submitting enrollment applications, maintaining provider information, following up with insurance companies, tracking application statuses, and ensuring credentials and supporting documentation remain accurate and current.

The ideal candidate has hands-on experience with payer enrollment and provider credentialing and understands how to independently manage applications from initial submission through approval. Strong organization, persistence, accuracy, and follow-up skills are essential, as you will be managing multiple providers, payers, deadlines, and application statuses simultaneously.
Key Responsibilities
Payer Enrollment

- Prepare, complete, and submit provider enrollment applications to commercial insurance payers, Medicare, Medicaid, and other applicable health plans.

- Manage payer enrollment applications from initial submission through approval and effective date.

- Follow up directly with insurance companies regarding pending applications, missing documentation, corrections, and enrollment status.

- Respond promptly to payer requests for additional information or documentation.

- Track application submissions, reference numbers, effective dates, payer decisions, and outstanding requirements.

- Assist with payer-related updates such as demographic changes, practice location updates, provider additions, terminations, and other enrollment maintenance.

- Identify enrollment delays or issues and proactively work with payers and internal teams toward resolution.

- Maintain accurate records of provider participation and payer enrollment status.

Provider Credentialing & Recredentialing

- Manage initial credentialing and re-credentialing requirements for healthcare providers.

- Collect, review, organize, and maintain provider credentialing documents.

- Verify provider information, including NPI, licenses, certifications, education, work history, malpractice coverage, and other required credentials.

- Audit provider files for missing, inaccurate, outdated, or expired documentation.

- Monitor expiration and renewal dates and proactively follow up on required documentation.

- Prepare and submit credentialing and re-credentialing applications accurately and within required timelines.

- Maintain complete and audit-ready credentialing files.

- Assist with resolving credentialing discrepancies or incomplete applications.

Provider Data & Application Management

- Maintain accurate provider demographic and professional information across credentialing and payer systems.

- Ensure consistency of provider information across applications, payer portals, and internal records.

- Maintain credentialing and payer enrollment trackers to provide clear visibility into pending, completed, and outstanding applications.

- Document communications and follow-up activities with payers.

- Communicate with providers and internal stakeholders regarding missing documentation, application updates, and enrollment requirements.

- Escalate potential credentialing or enrollment issues when necessary.

Requirements
Experience Requirements

- Hands-on experience with payer enrollment and provider credentialing is strongly preferred.

- Experience completing and submitting healthcare provider enrollment applications.

- Familiarity with commercial payers, Medicare, and/or Medicaid enrollmen