Credentialing & Health Plan Enrollment Specialist

3 weeks ago

Santa Rosa, Philippines Buscojobs Full time

Overview This is a remote position. Schedule : Monday–Thursday, 8:00 AM – 5:30 PM EST; Friday, 8:30 AM – 12:30 PM EST Contract Duration : 3 months Total Weekly Hours : 42 Hours Our client is seeking a Credentialing & Health Plan Enrollment Specialist to support provider demographic changes, credentialing, and health plan enrollment for physicians and ancillary providers within a clinical group practice. This role requires close collaboration with providers, practice administrators, billing vendors, health plans (commercial and governmental), and credentialing vendors to ensure compliance, accuracy, and efficiency. The Specialist will be responsible for maintaining credentialing documentation, ensuring compliance with healthcare regulations, and supporting enrollment processes that enable timely and accurate reimbursement. Success in this role requires strong organizational skills, attention to detail, and the ability to effectively manage multiple stakeholders. Responsibilities Manage the full credentialing lifecycle for healthcare providers, including initial credentialing, re-credentialing, and health plan enrollment Ensure credentialing documentation is accurate, complete, and compliant with regulatory standards and payer requirements Maintain up-to-date knowledge of healthcare regulations, accreditation standards, and payer policies Collaborate with internal teams, providers, and external agencies to resolve credentialing issues and ensure timely processing Oversee health plan enrollment processes, including eligibility verification, application submission, and status tracking Support billing and coding teams by aligning credentialing and enrollment data with reimbursement processes Maintain accurate provider files, licenses, DEA certificates, malpractice coverage, and other required documentation Assist providers with CAQH applications and other enrollment-related requirements Participate in quality improvement initiatives to streamline credentialing and enrollment operations Ensure compliance with HIPAA regulations and maintain confidentiality of sensitive data Requirements Bachelor’s degree in Healthcare, Business, Finance, or related field OR a minimum of 3 years of equivalent healthcare experience 3–5 years of proven experience in credentialing and health plan enrollment (Medicare, Medicaid, commercial insurers, and TPAs) Strong knowledge of healthcare regulations, accreditation standards, and payer requirements High attention to detail with strong record-keeping and compliance management skills Proficiency in Microsoft Office Suite (Excel, Word, PowerPoint, Visio) and online credentialing databases Excellent written and verbal communication skills; professional interaction with diverse stakeholders Strong problem-solving, decision-making, and organizational abilities Ability to work independently with minimal supervision while contributing to a collaborative team environment Competencies Results-driven and detail-oriented Strong interpersonal and communication skills Ability to handle sensitive information with confidentiality Customer service mindset with a commitment to quality and compliance Adaptability in a dynamic, fast-paced healthcare environment Work Environment & Schedule Standard business hours with occasional extended hours or weekend requirements Regular use of standard office equipment and virtual collaboration tools Perks Independent Contractor Perks Permanent work-from-home arrangement Immediate hiring Commissions and incentives #J-18808-Ljbffr

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