Provider Enrollment

We are seeking a highly organized and detail-oriented Provider Enrollment / Credentialing Specialist with strong knowledge of US healthcare payer enrollment processes. The ideal candidate will manage full-cycle credentialing and enrollment for healthcare providers, ensuring timely and accurate submission of applications, payer contracts, updates, and renewals. This role requires excellent communication, follow-up skills, and the ability to work independently while maintaining high-quality standards.

Key Responsibilities:Full-Cycle Enrollment & Credentialing

• Collect, verify, and validate all required provider documentation (licenses, NPI, CAQH, malpractice, W-9, board certifications, resumes, etc.).
• Prepare, complete, and submit provider enrollment applications to Medicare, Medicaid, and commercial payers.
• Maintain and update CAQH profiles, ensuring all data is current and re-attested.
• Complete recredentialing and demographic updates (address changes, TIN updates, specialty updates, group linkage, etc.).
• Ensure providers are linked to the correct billing groups, facility locations, and taxonomies as required by the payer.

Follow-Up & Compliance

• Track and manage all submitted applications through approval, rejections, or requests for additional information.
• Follow up with payers for application status, missing details, or delays.
• Respond to payer requests, clarifications, and RFI (Requests for Information).
• Review and obtain contract agreements, ensure provider signatures, and maintain organized contract records.
• Ensure all enrollments meet payer-specific compliance rules (Medicare PECOS, Medicaid portals, commercial payer portals).

Communication & Coordination

• Work closely with providers, internal teams, and payer representatives to expedite enrollment.
• Communicate expected turnaround times, missing documents, and anticipated Go-Live dates.
• Notify management of any risks, delays, or payer issues impacting credentialing timelines.

Recordkeeping & Reporting

• Maintain up-to-date tracking sheets and dashboards for every provider and every payer.
• Document status, timelines, and next steps for all ongoing enrollment projects.
• Provide weekly reports on pending and completed enrollments.

Required Skills & Qualifications:

• 2–4 years of experience in US healthcare credentialing or provider enrollment.
• Strong knowledge of Medicare, Medicaid, and commercial payer enrollment processes.
• Familiarity with PECOS, CAQH, Availity, NPPES, and specific payer portals.
• Experience with credentialing for physicians, NPs, PAs, behavioral health, or multiple specialties.
• Ability to understand provider contracts and payer participation agreements.
• Strong organizational skills and attention to detail.
• Excellent communication and follow-up skills.
• Ability to work independently and manage multiple provider applications simultaneously.
• Proficiency in Excel/Google Sheets and documentation management.

Preferred Qualifications:

• Experience working with RCM companies, MSOs, or medical groups.
• Knowledge of facility enrollment, group contracts, and delegated credentialing.
• Familiarity with payer data validation, taxonomy requirements, and TIN/NPI linking.
• Understanding of credentialing compliance standards (NCQA, URAC, HIPAA).

Work Arrangement & Availability:

• Contract or full-time availability depending on business needs.
• Must be able to attend scheduled check-in meetings or calls as required.
• Ability to prioritize multiple tasks in a deadline-driven environment.

Job Types: Full-time, Permanent

Pay: Php25, Php35,000.00 per month

Benefits:

• Work from home

Application Question(s):

• How many years of experience do you have with Provider Enrollment?
• What type of provider or group specialty have you worked in in your previous projects?
• Which state rules are you familiar with or have experience with the Enrollment application?
• What is your expected compensation for this job?
• Please summarize what CAQH and PECOS are used for.

Location:

• Philippines (Required)

Work Location: Remote