Payer Enrollment Specialist & Credentialing Expert

Allied Digestive Health; West Long Branch (NJ); On-site; USD 52,000 - 76,000; Full time

Job summary

Allied Digestive Health is seeking a detail-oriented Credentialing Specialist to coordinate provider enrollment and revalidation with commercial, Medicare, Medicaid, and other payers. You will monitor statuses, maintain accurate provider data, and support credentialing operations in a fast-paced office.

The role requires 2+ years in healthcare payer enrollment or related experience, strong communication, and proficiency with credentialing systems.

Qualifications

• 2+ years of healthcare payer enrollment, credentialing, revenue cycle, or related healthcare administration experience.
• High school diploma or equivalent; associate's or bachelor's degree preferred.
• Knowledge of Medicare, Medicaid, and commercial payer enrollment processes.
• CPMSM, CPCS, CPES, or related industry certification is preferred but not required.
• Strong communication and organizational abilities.

Responsibilities

• Coordinate provider enrollment, re-enrollment, and revalidation with commercial, Medicare, Medicaid, and other payers.
• Monitor enrollment status and follow up with payers for timely processing and approval.
• Maintain provider demographic, licensure, credentialing, and enrollment data in internal systems.
• Coordinate meetings with health plans and/or funders.
• Manage provider roster updates, contract participation changes, terminations, and location changes.
• Research and resolve enrollment-related claim denials and reimbursement issues.
• Ensure compliance with payer requirements, regulatory standards, and organizational policies.
• Generate enrollment status reports and communicate progress to stakeholders.
• Serve as a subject matter expert on payer enrollment processes and requirements.
• Utilize credentialing and practice management software.
• Provide administrative support to the Credentialing Department as needed.
• Maintain confidentiality of sensitive provider and organizational information.

Skills

Communication skills

Organizational skills

Multitasking

Problem-solving

Independent work

Customer service

Excel proficiency

MS Office

Education

High school diploma or equivalent

Associate's or Bachelor's degree preferred

CPMSM/CPCS/CPES certifications preferred

Tools

Credentialing software

Microsoft Office

Job description

Allied Digestive Health is seeking a detail-oriented Credentialing Specialist to coordinate provider enrollment and revalidation with commercial, Medicare, Medicaid, and other payers. You will monitor statuses, maintain accurate provider data, and support credentialing operations in a fast-paced office.

The role requires 2+ years in healthcare payer enrollment or related experience, strong communication, and proficiency with credentialing systems.