Professional Healthcare Provider Enroller

19 hours ago

Ayala Alabang, National Capital Region, Philippines beBeeCredentialing Full time $55,000 - $65,000
Credentialing Specialist Role Overview

We are seeking a highly skilled Credentialing Specialist to join our remote team. In this role, you will be responsible for overseeing the credentialing and enrollment processes for healthcare providers practicing in Maryland.

Key Responsibilities:
  • Manage the credentialing and recredentialing processes for Maryland-based healthcare providers, including physicians, nurse practitioners, and allied health professionals.
  • Evaluate all provider files against Maryland state regulations, insurance guidelines, and national accreditation standards.
  • Process and submit credentialing applications and enrollment forms to commercial payers, Medicaid, and Medicare (via PECOS).
  • Maintain and update provider data in credentialing systems such as CAQH, NPPES, and internal databases.
  • Track and monitor expirable items such as licenses, certifications, and recredentialing deadlines.
  • Negotiate with insurance companies, government agencies, and internal departments to resolve credentialing-related issues.
  • Stay up-to-date with Maryland payer requirements, credentialing laws, and healthcare regulations.
  • Verify credentials and maintain accurate, complete provider profiles.
Qualifications:
  • Prior experience in healthcare credentialing or provider enrollment, preferably with Maryland-based providers.
  • Familiarity with Maryland-specific credentialing standards, including Maryland Medicaid and regional payers.
  • Proficiency with credentialing platforms such as CAQH, PECOS, and NPPES.
  • Familiarity with the EPREP Portal, including provider registration and compliance functions.
  • Exceptional attention to detail and ability to manage multiple deadlines effectively.
  • Strong written and verbal communication skills; professional in interactions with both internal and external stakeholders.
  • Self-motivated and reliable in a fully remote work environment.
  • Demonstrated commitment to confidentiality and compliance with healthcare regulations.

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