Primary Responsibilities
- Own end-to-end provider credentialing and enrollment processes from onboarding through approval and ongoing maintenance, delivering a high-touch, white-glove provider experience
- Serve as the primary escalation point for complex credentialing issues, partnering with third-party vendor (Advantum) and insurance payors to drive timely resolution
- Manage consistent, professional communication with assigned providers across a portfolio of 50+ practice locations, ensuring alignment and responsiveness
- Oversee collection, validation, and ongoing maintenance of provider data and onboarding documentation to ensure accuracy, completeness, and compliance
- Maintain end-to-end visibility and accountability for enrollment progress, followups,
and project initiatives through effective ticketing system management and tracking
- Ensure integrity, accuracy, and compliance of provider records and databases in
accordance with internal standards and regulatory requirements
- Guide providers through credentialing and re-credentialing processes, proactively
addressing inquiries and ensuring timely resolution of outstanding items
- Develop and maintain strong relationships with health plans and insurance payor
representatives to support successful enrollment outcomes
- Partner cross-functionally with internal stakeholders, including:
o Revenue Cycle Management: Resolve billing issues related to credentialing status and enrollment gaps o Payor Relations: Align on timely execution of payor contracts to support accurate enrollment submissions
- Proactively identify, analyze, and resolve enrollment gaps, delays, and risks
impacting practice operations and revenue cycle performance
- Ensure strict compliance with all applicable state and federal regulations, including
Medicare and Medicaid requirements
- Contribute to team initiatives focused on enrollment cleanup, process
improvement, and operational efficiency
- Perform additional credentialing, compliance, and operational support duties as
assigned Minimum Qualifications / Requirements
- Minimum of 2 years of direct provider enrollment and credentialing experience
required
- 2–3 years of administrative experience in a healthcare environment preferred
- Working knowledge of Medicare, Medicaid, and commercial payor enrollment
processes
- Well versed within CAQH, NPPES, PECOS, and payor portals (e.g., Availity, One
HealthCare ID, etc.)
- High School diploma or GED required (Associate’s or Bachelor’s degree preferred)
- Strong organizational skills with exceptional attention to detail
- Ability to manage multiple priorities, deadlines, and competing demands in a fastpaced
environment
- Excellent communication, interpersonal, problem-solving, and critical thinking
skills
- Ability to work independently with minimal supervision while maintaining
accountability
- Comfortable working in a remote environment with video-based collaboration
Key Competencies
- Customer-focused with a high level of professionalism
- Strong follow-through and accountability
- Adaptability and resourcefulness in problem-solving
- Cross-functional collaboration and relationship-building
- Process-driven with a focus on accuracy and compliance
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