Payer Credentialing & Enrollment Specialist

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Franklin (TN)

On-site

USD 30,000 - 47,000

Full time

2 days ago

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Job summary

Fast Pace Health is seeking a skilled Payer Enrollment Specialist to lead, coordinate, and maintain the payer enrollment process across multiple health plan clients. You will manage initial enrollments, revalidations, amendments, and roster submissions while ensuring regulatory compliance and accurate documentation.

The role requires deep knowledge of enrollment lifecycles, CAQH and payer portals, and strong collaboration with health plans and providers.

Qualifications

Minimum of 4 years of progressive payer enrollment experience within a multi-location medical group or multi-specialty healthcare organization.
Multi-state payer enrollment experience.
Experience with payer enrollment and credentialing systems such as CredentialStream or similar.
Experience utilizing payer portals including Availity, CAQH, PECOS, NPPES, Medicare, Medicaid, and commercial payer portals.

Responsibilities

Obtain, verify, analyze, and maintain all documentation required for provider, group, facility, and ancillary payer enrollments, ensuring accuracy and completeness prior to submission.
Coordinate and manage the payer enrollment lifecycle from initiation through approval, including application preparation, submission, follow-up, resolution of deficiencies, and final payer activation.
Prepare, submit, track, and maintain provider and organizational enrollments, revalidations, recredentialing applications, demographic updates, ownership changes, and provider roster submissions for commercial, Medicare, Medicaid, and other government payers.
Initiate payer contracting requests and collaborate with contracting to facilitate network participation.
Track all enrollment activities within CredentialStream ensuring documentation, status updates, milestones, and approvals are accurately recorded and maintained.
Maintain and continuously update payer-specific enrollment checklists, requirements, submission guidelines, and supporting documentation standards to ensure accurate first-pass submissions and reduce enrollment delays and denials.
Follow payer-specific enrollment checklists and established workflows to ensure applications are submitted accurately, completely, and within required turnaround times.
Conduct ongoing payer follow-up activities to resolve enrollment issues, obtain status updates, address deficiencies, and expedite approvals when necessary.
Interface directly with health plans, Medicare Administrative Contractors (MACs), Medicaid agencies, provider representatives, and payer relations contacts to support enrollment and credentialing activities.
Ensure ongoing accuracy, completeness, and maintenance of provider CAQH profiles, attestations, supporting documents, and related databases.
Coordinate CLIA certificate applications, renewals, updates, and maintenance activities for applicable locations.
Responsible for learning the aspects of compliance in the company by completing all mandatory compliance training
The ability to maintain friendly, cordial relations with all employees.
The ability to build and maintain confidence and credibility with all employees.
The ability to maintain friendly, cordial relations with all clients and employees; maintain a positive work atmosphere by acting and communicating in a manner that results in a positive work relationship with customers, co-workers and managers.
The ability to perform the physical, use of senses, cognitive, and environmental functions of the position, as specified on the physical demands.
Ability to comply with Company standards of operations.
Ability to adhere to the Core Values of the Company, of teamwork, communication, empowerment, quality of care, and friendliness.