Provider Enrollment and Credentialing Lead

Hire Overseas; A distancia; MXN 200,000 - 400,000; Jornada completa

Descripción de la vacante

A healthcare organization is seeking a detail-oriented Provider Enrollment and Credentialing Lead to support its operations. This role focuses on overseeing the provider credentialing process, ensuring compliance and timely activation across multiple states. Key responsibilities include managing payer workflows and enhancing billing accuracy. The ideal candidate has over 5 years of experience in healthcare operations and strong skills in using credentialing tools. The position is 100% remote, offering a dynamic work environment and significant growth opportunities.

Servicios

Paid in USD biweekly

Up to 14 days of Paid Time Off

Work from anywhere

Formación

• 5+ years of experience in healthcare operations.
• Deep understanding of credentialing impacts on billing.
• Skilled in payer portals for management.

Responsabilidades

• Manage the end-to-end provider credentialing process.
• Support end-to-end payer workflows including VOB.
• Coordinate provider enrollments to ensure timely activation.

Conocimientos

Organized

Detail-oriented

Strong communicator

Analytical

Proactive

Herramientas

CAQH

Availity

Descripción del empleo

We’re looking for a detail-oriented and process-driven Provider Enrollment and Credentialing Lead to support our provider enrollment and revenue cycle operations as the company expands into new states.

This role is ideal for someone who thrives on accuracy, structure, and proactive problem-solving —ensuring providers are credentialed on time, payer workflows are clean and compliant, and no claims fall through the cracks. You’ll play a critical role in bridging credentialing, billing, and payer management to help keep operations running seamlessly.

🎁 Perks & Benefits

• 💵 Paid in USD every 15th & 30th of the month
• 🌴 Up to 14 days of Paid Time Off annually (starting Day 1)
• 📅 Observance of Holidays (based on your location)
• 🏡 100% remote – work from anywhere
• 🌍 Be part of meaningful, high-impact healthcare operations projects
• 🚀 Work with a fast-moving, collaborative team where your input drives real results

What You’ll Be Doing

🩺 Provider Enrollment & Credentialing

• Manage the end-to-end provider credentialing process , from initial submission to approval, across multiple states and payers.
• Research payer-specific requirements and maintain up-to-date documentation for all enrollments.
• Track credentialing statuses, expirations, and revalidations through a live credentialing tracker for full visibility.
• Coordinate both group and individual provider enrollments , ensuring compliance and timely activation.
• Forecast provider go-live timelines and communicate proactively with internal teams to align scheduling and billing readiness.
• Identify and resolve enrollment issues with payers, escalating as needed to minimize delays.
• Develop and maintain credentialing playbooks to standardize processes and support scalability.

💰 Revenue Cycle Management (RCM)

• Support end-to-end payer workflows , including Verification of Benefits (VOB), prior authorizations, and fee schedule setup .
• Audit payer setup in the system to ensure data accuracy for clean claim submission.
• Collaborate with billing teams to resolve issues that impact claim processing or reimbursement .
• Conduct payer research —including eligibility, coverage limits, submission processes, and reimbursement policies—to reduce denials.
• Track and support copay and coinsurance collection , including payment plan documentation and reporting.
• Ensure full compliance with CMS billing standards, NCQA guidelines, and payer credentialing requirements.
• Stay informed on Medicaid and commercial payer policy updates and communicate key changes to internal teams.

📞 Cross-Functional Communication

• Act as the point of contact for payers, providers, and internal teams , ensuring timely and clear communication.
• Provide updates on credentialing and RCM statuses to leadership and key stakeholders.
• Help document and improve operational workflows for better efficiency and accuracy.

✅ Who You Are

• 5+ years of experience in healthcare operations, provider enrollment, credentialing, or RCM .
• Deep understanding of how credentialing impacts billing and revenue cycles.
• Organized, analytical, and highly detail-oriented with excellent follow-through.
• Skilled in using tools like CAQH, Availity, or payer portals for credentialing and RCM management.
• Strong communicator who can collaborate effectively across departments and with external partners.
• Comfortable with multi-state operations, payer variations, and regulatory compliance .
• Adaptable and proactive—able to manage multiple priorities and adjust quickly as processes evolve.

Bonus Points

• Experience working with Medicaid, Medicare, and commercial payer networks .
• Background in ABA, behavioral health, or multi-specialty provider credentialing.
• Knowledge of claims auditing, denial management, or in-house RCM transitions.

🎯 Success Metrics

• Zero provider idle time due to credentialing or enrollment delays.
• 100% payer workflows completed accurately and on time.
• Reduced claim denials through proactive payer setup and process audits.
• Consistent regulatory compliance across all payer and provider types.
• Improved revenue flow through alignment between credentialing and billing functions.

📩 How to Apply

Only candidates who submit a Loom video will be moved to the next step of the hiring process.

Please submit :

• ✅ Your updated resume
• 🎥 A 1–2 minute Loom video introducing yourself and describing your experience with provider enrollment and RCM processes.
• 🧾 (Optional) Examples of trackers, checklists, or process documentation you’ve built or managed.

🧠 If you’re a healthcare operations expert who understands how credentialing and billing power great patient care—we’d love to hear from you.

📋 ApplicationProcessOverview

Ourcomprehensiveselectionprocessensureswefindtherightfitforbothyouandourclients :

• InitialApplication -Submityourapplicationandcompleteourprequalifyingquestions
• VideoIntroduction -RecordabriefvideointroductiontoshowcaseyourcommunicationskillsandworkexperienceRole-SpecificAssessment -Completeahomeworkassignmenttailoredtotheposition(ifapplicable)
• RecruitmentInterview -Initialscreeningwithourtalentteam
• ExecutiveInterview -Meetwithseniorleadershiptodiscussrolealignment
• ClientInterview -Finalinterviewwiththeclientteamyou'dbesupporting
• JobOffer -Successfulcandidatesreceiveaformaloffertojointheteam

Each stage is designed to evaluate your fit for the role while giving you insights into our company culture and expectations. We'll keep you informed throughout the process and provide feedback at each step.