Credentialing Specialist: Payer Enrollment & Compliance Pro

AdvantixxRCM; Las Vegas (NV); On-site; USD 55,000 - 75,000; Full time

Job summary

AdvantixxRCM is seeking an experienced Credentialing Specialist to manage provider credentialing, payer enrollment, recredentialing, revalidation, and ongoing maintenance for healthcare clients. The role requires organizing multiple providers and applications while meeting deadlines.

The ideal candidate will handle CAQH profiles, PECOS enrollment, and provider enrollment across Medicare, Medicaid, and commercial payers. Strong attention to detail and independent work are essential.

Qualifications

• Minimum 2 years of healthcare credentialing or provider enrollment experience preferred.
• Experience with Medicare and/or Medicaid enrollment.
• Experience maintaining CAQH profiles.
• Familiarity with PECOS and NPPES.
• Understanding of individual and group provider enrollment.
• Experience communicating with insurance payer credentialing departments.
• Strong organizational and follow-up skills.
• Excellent attention to detail.
• Ability to manage multiple applications simultaneously.
• Proficiency with electronic payer portals and document management systems.

Responsibilities

• Complete initial provider credentialing and payer enrollment applications.
• Manage Medicare and Medicaid enrollment processes.
• Complete commercial insurance payer applications.
• Maintain and update provider CAQH profiles.
• Manage PECOS enrollment and maintenance activities.
• Complete provider recredentialing and revalidation.
• Track application status from submission through completion.
• Follow up directly with insurance companies regarding pending applications.
• Maintain provider demographic information with payers.
• Process changes involving practice locations, addresses, tax information, ownership, and provider affiliations as appropriate.
• Assist with provider additions and terminations.
• Complete group and individual provider linking/affiliation requests.
• Maintain credentialing records and supporting documentation.
• Track provider licenses, certifications, NPI information, malpractice coverage, DEA information when applicable, and other credentialing requirements.
• Monitor expiration and renewal dates.
• Respond to payer requests for additional information.
• Maintain accurate credentialing trackers.
• Document payer reference numbers, effective dates, participation status, and follow-up activity.
• Coordinate with billing staff to resolve credentialing-related claim denials.
• Escalate enrollment delays or payer issues to the Operations Manager.
• Communicate credentialing status and outstanding requirements to clients.

Skills

Credentialing

Payer enrollment

CAQH maintenance

PECOS enrollment

NPPES

Provider enrollment

Multitasking

Detail-oriented

Communication skills

Independent work

Tools

Electronic payer portals

Document management systems

Job description

AdvantixxRCM is seeking an experienced Credentialing Specialist to manage provider credentialing, payer enrollment, recredentialing, revalidation, and ongoing maintenance for healthcare clients. The role requires organizing multiple providers and applications while meeting deadlines.

The ideal candidate will handle CAQH profiles, PECOS enrollment, and provider enrollment across Medicare, Medicaid, and commercial payers. Strong attention to detail and independent work are essential.