Credentialing & Health Plan Enrollment Specialist

Overview 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. Job Highlights Hourly Rate: USD 9, the equivalent in your local currency Work Arrangement: Work from home Note: Since this is a permanent work-from-home position and an “Independent Contractor” arrangement, the candidates must have their own computer and internet connection. They will handle their own benefits and taxes. The professional fees are on hourly rates and the rate depends on your performance in the application process. 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 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 Standard business hours with occasional extended hours or weekend requirements Permanent work-from-home arrangement #J-18808-Ljbffr