Experienced Provider Enrollment Specialist – Medicare, Medicaid & Commercial Payers

Experienced Provider Enrollment Specialist – Medicare, Medicaid & Commercial Payers Pay: Starting at $25.00 per hour, based on experience Job Type: Full-time Expected Hours: 40 hours per week Work Location: Remote

About Us

Join a growing medical billing and healthcare technology company that is transforming how physician practices manage their revenue cycles. We provide comprehensive provider enrollment, credentialing, and revenue cycle management services to physician practices nationwide, combining innovative technology with responsive, hands-on support. As our company and client base continue to expand, we are seeking an experienced Provider Enrollment Specialist to join our remote credentialing team. This is an opportunity to work in a fast-paced, collaborative environment where your payer-enrollment expertise will have a direct impact on our clients and their providers. Position Overview The Provider Enrollment Specialist is responsible for independently managing provider and group enrollment activities with Medicare, Medicaid, and commercial insurance payers across multiple states. This is a payer-enrollment position. It is not limited to maintaining CAQH profiles, verifying provider credentials, or completing hospital privileging applications. The successful candidate must have hands-on experience completing payer applications from initial submission through approval. This includes researching payer requirements, resolving returned or delayed applications, following up consistently, maintaining accurate tracking, and communicating clearly with providers, clients, payers, and internal teams. You will manage multiple providers, practices, payers, applications, and deadlines simultaneously. This position requires strong organization, accountability, independent judgment, and consistent follow-through.

Key Responsibilities

• Independently manage provider and group enrollment, credentialing, and recredentialing with Medicare, Medicaid, and commercial insurance payers.
• Prepare and submit initial enrollments, revalidations, reassignment applications, demographic changes, practice-location additions, terminations, and other payer updates.
• Complete Medicare enrollment activities through PECOS, including individual and group enrollments, reassignments, revalidations, and changes of information.
• Complete enrollment activities through multiple state Medicaid portals.
• Maintain and attest provider CAQH profiles and ensure information is complete, current, and consistent with payer applications.
• Use payer portals and enrollment systems, including PECOS, NPPES, I&A, CAQH, Availity, state Medicaid portals, and other payer-specific systems.
• Monitor every assigned application from initial submission through final approval.
• Conduct timely and documented payer follow-up regarding outstanding requirements, application delays, returned applications, and effective dates.
• Research enrollment requirements and independently determine the appropriate next steps when an application encounters a problem.
• Identify missing, conflicting, or inaccurate provider information before an application is submitted.
• Maintain accurate application statuses, follow-up dates, effective dates, payer records, and supporting documentation in credentialing databases and tracking systems.
• Communicate directly with providers regarding required information, signatures, attestations, and supporting documentation.
• Provide clients and internal teams with clear, accurate, and timely status updates.
• Identify potential problems early and escalate issues with a summary of the research completed and the recommended next step.
• Follow established workflows, productivity expectations, documentation standards, and follow-up requirements.
• Assist with urgent enrollment needs and changing client priorities.
• Perform other provider-enrollment and credentialing duties as assigned.

Required Qualifications

• Minimum of two years of direct, hands-on provider enrollment experience with Medicare, Medicaid, and commercial insurance payers.
• Demonstrated experience independently completing payer applications from initial submission through approval.
• Direct experience with Medicare PECOS enrollments, reassignments, revalidations, and changes of information.
• Direct experience completing enrollments through state Medicaid portals.
• Experience managing payer enrollment for multiple providers, practices, locations, and tax identification numbers.
• Experience using CAQH, PECOS, NPPES, I&A, Availity, and payer-specific portals.
• Ability to independently research payer requirements, application problems, enrollment delays, and effective-date issues.
• Ability to manage a high-volume workload involving multiple applications and competing deadlines.
• Strong written and verbal communication skills.
• Strong organizational skills and exceptional attention to detail.
• Demonstrated ownership, accountability, and follow-through.
• Proficiency with Microsoft Excel, Outlook, and other Microsoft Office applications.
• Ability to work independently while collaborating with a remote team.

Preferred Qualifications

• Two or more years of direct provider and payer enrollment experience.
• Multi-state Medicare and Medicaid enrollment experience.
• Experience enrolling physician practices that operate under multiple tax identification numbers.
• Experience with physician groups providing services in skilled nursing, rehabilitation, hospital, or other facility-based settings.
• Experience with Modio or a comparable credentialing management system.
• Experience working with both U.S.-based and offshore support teams.

Education

• High school diploma or GED required.

Schedule and Compensation

• Full-time position: 40 hours per week.
• Normal business hours, Monday through Friday.
• Fully remote work environment.
• Starting pay of $25.00 per hour, based on experience.
• Quarterly performance bonus eligibility after 90 days, based on productivity and performance goals.

Pay: From $25.00 per hour Expected hours: 40.0 per week Benefits:

• 401(k) matching
• Dental insurance
• Health insurance
• Paid time off
• Referral program
• Vision insurance

Experience:

• Medicare PECOS: 2 years (Preferred)
• State Medicaid Enrollment: 2 years (Preferred)
• Provider enrollment MCR, MCD & Commercial Payors: 3 years (Preferred)

Work Location: Remote