Credentialing Specialist (Payer Enrollment)

Lumexa Imaging; Charlotte (NC); On-site; USD 52,000 - 68,000; Full time

Job summary

Lumexa Imaging seeks a Credentialing Specialist (Payer Enrollment) to enroll facilities with commercial payers, Medicare, and Medicaid, ensuring timely reimbursement for services.

The role emphasizes accurate data management, cross-department collaboration, and proactive follow-up to resolve enrollment issues and shorten approval timelines.

Qualifications

• Knowledge and understanding of credentialing and enrollment processes.
• Familiarity with NPI and TIN numbers.
• Ability to organize, prioritize, and manage multiple tasks.
• Excellent verbal and written communication skills.
• Strong attention to detail.
• Ability to establish and maintain relationships with providers and internal teams.
• Proficient use of Microsoft Office applications and credentialing software.
• MD Staff software experience is a plus.

Responsibilities

• Prepare, submit, and track enrollment applications and updates with payers.
• Proactively follow up with insurance representatives to track status and resolve issues.
• Maintain and audit provider data in CAQH, PECOS, and NPPES.
• Coordinate enrollment data across billing, compliance, and operations teams.
• Investigate and resolve enrollment-related claim denials or delays.

Skills

Credentialing knowledge

NPI/TIN knowledge

Organizational skills

Communication skills

Attention to detail

Relationship management

MS Office

Credentialing software

MD Staff experience

Tools

Microsoft Office (Word, Excel, SharePoint)

MD Staff software

Job description

The Credentialing Specialist (Payer Enrollment) is responsible for enrolling healthcare facilities with commercial insurance payers, Medicare, and Medicaid to ensure timely reimbursement for services rendered. Manage the application process, track credentialing status, and resolve enrollment issues. This role requires attention to detail, knowledge of healthcare regulations, and strong communication skills to coordinate with multiple internal departments and insurance companies effectively.

Essential Duties and Responsibilities:

• Application Management: Prepare, submit, and track enrollment applications, re-credentialing packets, and demographic updates with commercial and government payers.
• Payer Follow-up: Proactively communicate with insurance representatives to track application status, resolve processing errors, and shorten approval timelines.
• Database Maintenance: Manage, update, and audit provider information in centralized databases like CAQH, PECOS, and NPPES.
• Internal Collaboration: Coordinate with the broader billing, compliance, and operations teams to align enrollment data across the organization's practice management systems.
• Denial Troubleshooting: Investigate and resolve claim rejections or delays that stem from provider enrollment or taxonomy errors.

Required Experience:

• A minimum of two years of payer enrollment experience

Knowledge and Skills:

• Knowledge and understanding of the credentialing and enrollment process
• Strong familiarity with medical provider numbers such as NPI (National Provider Identifier) and TIN (Tax Identification Number).
• Ability to organize and prioritize work and manage multiple priorities
• Excellent verbal and written communication skills
• Excellent attention to detail
• Ability to establish and maintain effective working relationships with providers, management, staff, and contacts outside the organization.
• Proficient use of Microsoft Office applications (Word, Excel, SharePoint) and credentialing software
• MD Staff software experience a plus