Credentialing and Payer Enrollment Specialist – Part-time
Posted 1 month ago
You'll complete your application on RCM Staff LLC's career site.
About the Role
This staffing firm connects medical practices and revenue cycle management companies with trained medical billing, coding, and administrative personnel. All staff members are HIPAA-compliant and proficient in using electronic health records and insurance portals, with oversight provided by AAPC-certified leadership to ensure operational excellence. The Credentialing and Payer Enrollment Specialist is a part-time, remote position focused on managing the administrative tasks required to authorize providers for insurance networks. This role is ideal for organized professionals seeking to grow within an expanding organization, with the possibility of increasing work hours as business needs evolve.
Requirements
- Minimum of two years of hands-on experience in U.S. payer enrollment and provider credentialing.
- Deep knowledge of government programs like Medicaid and Medicare, alongside private insurance plans.
- Proven ability to use PECOS, CAQH ProView, and NPPES.
- Capable of utilizing insurance websites and payer portals efficiently.
- Professional skills in making outbound calls to network representatives and provider relations departments.
- Strong verbal and written English communication abilities.
- Self-sufficient, with the capacity to juggle multiple complex enrollment tasks.
- Must maintain a professional home office space with dependable internet access.
- Availability to work during business hours in the U.S. Central Time zone.
- Experience in behavioral health or orthopedic enrollment, familiarity with Texas insurance plans, knowledge of various state Medicaid portals, or proficiency with platforms like TherapyNotes, Practice Fusion, or AdvancedMD is highly desired.
Responsibilities
- Prepare and file new payer enrollment forms for group practices and individual providers for government and private insurance plans.
- Manage, update, and attest to CAQH ProView profiles.
- Keep provider data current in NPPES and PECOS systems, including handling revalidations and demographic updates.
- Monitor application status by frequently communicating with payer relations teams via email, telephone, and online portals to secure effective dates.
- Oversee the revalidation and recredentialing schedule to avoid any interruptions in provider status.
- Gather and categorize essential credentialing materials, including malpractice certificates, DEA registrations, and state medical licenses.
- Process group modifications and roster updates for payers.
- Record all interactions and confirmation numbers within the client's internal tracking software.
- Deliver recurring weekly progress updates to clients.
- Maintain strict HIPAA compliance when handling sensitive patient information.
Benefits & Perks
- This role currently provides a remote schedule of 20 hours each week, with the opportunity to move to full-time status as the workload increases.
Note: This listing is summarized and paraphrased by WorkNow from a publicly posted role. For the original wording and full details, please refer to the employer's official posting.
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