Provider Enrollment & Credentialing Specialist (2734)
On-site · Franklin, Tennessee, United States
Job Summary
Remote Provider Enrollment & Credentialing Specialist to staff and resolve payer enrollment and credentialing issues. Serves as the first point of contact, manages enrollment with commercial and government payers, maintains CAQH/PECOS/NPPES/CMS profiles, creates and distributes reports, researches state enrollment requirements, documents enrollment and billing requirements for payer contracts, renews licenses (Professional, DEA, Controlled Substance), validates provider credentials, and collaborates with Revenue Cycle and billing staff to resolve denials or authorization issues. Requires meticulous follow-through, leadership in team development, strong communication, and proficiency with Windows/MS Office; education requirement is High School diploma or equivalent with preferred 2 years of office experience or college coursework.
Required Qualifications
- High school diploma or equivalent
- Two (2) years office experience or college course work preferred
- Knowledge of health plan billing and enrollment preferred
- PECOS and CAQH experience preferred
- Veritystream experience a plus
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