Credentialing & Enrollment Specialist: Protect Revenue

Prestige Healthcare Resources Inc.; Washington; On-site; USD 32,000 - 34,000; Full time

Job summary

Prestige Healthcare Resources, Inc. (PHRI) seeks a Credentialing & Provider Enrollment Specialist to own the end-to-end credentialing lifecycle for clinicians and contractors, ensuring licenses, certifications, and enrollments are accurate and current.

You will coordinate with DC Medicaid, Maryland Medicaid, MCOs, PECOS, and payers, maintain CAQH ProView profiles, and support provider data integrity across systems, ensuring recurrent renewals and enrollment progress.

Qualifications

• At least 3 years of credentialing or provider enrollment experience, including Medicaid/MCOs.
• Hands-on experience with CAQH ProView, NPPES, PECOS, and payer portals.
• Knowledge of licensure requirements for behavioral health professionals in DC/MD.
• Experience with EHR or credentialing systems.
• Ability to manage multiple applications and renewal cycles.

Responsibilities

• Verify licenses, certifications, education, and work history before first assignment.
• Conduct and document required exclusions and screenings (OIG LEIE, SAM.gov, state Medicaid lists).
• Maintain audit-ready credentialing files for clinicians and contractors.
• Coordinate initial enrollment, recredentialing, and demographic updates across Medicaid, PECOS, and payers.
• Track applications from submission to approval and update renewals.

Skills

Credentialing

Provider enrollment

Medicaid enrollment

HIPAA compliance

Data integrity

Education

Bachelor’s degree

NAMSS certification (preferred)

Tools

CAQH ProView

NPPES

PECOS

Job description

Prestige Healthcare Resources, Inc. (PHRI) seeks a Credentialing & Provider Enrollment Specialist to own the end-to-end credentialing lifecycle for clinicians and contractors, ensuring licenses, certifications, and enrollments are accurate and current.

You will coordinate with DC Medicaid, Maryland Medicaid, MCOs, PECOS, and payers, maintain CAQH ProView profiles, and support provider data integrity across systems, ensuring recurrent renewals and enrollment progress.