Payor Credentialing & Enrollment Specialist

Menlo Ventures; United States; On-site; USD 65,000 - 67,000; Full time

Benefits offered by this job

Medical insurance

PTO 4 weeks

Work From Home stipend

401k

Job summary

Menlo Ventures is seeking a Credentialing and Enrollment Specialist in the United States to ensure clinicians are properly credentialed and enrolled in payor networks. You will manage credentialing, re-credentialing, and enrollment for physicians and allied providers across MCOs, Medicare and Medicaid, while maintaining records in CAQH and payor portals.

You will collaborate with Clinical Operations, Billing and Contracting teams, report to Licensing and Credentialing Team Lead, and drive timely

Qualifications

• Associates degree or equivalent combination of education and experience.
• 3–5 years of credentialing and enrollment experience.
• Knowledge of multi-state/national credentialing and enrollment.
• Experience with PECOS/Medicare and/or state Medicaid enrollment platforms.
• Knowledge of Google Workspace/Microsoft Office suites.
• NAMSS CPCS certification is a plus.

Responsibilities

• Review credentialing applications and ensure industry standard compliance.
• Perform primary source verification and coordinate committee reviews.
• Submit license, DEA, CSR requests promptly and accurately.
• Gather missing information from providers for enrollment submissions.
• Submit enrollment packets to payors (MCOs, Medicare, Medicaid).
• Monitor enrollment status and expedite approvals with payors.
• Maintain provider enrollment data in CAQH and payor portals.
• Act as liaison between providers, payors and internal teams to resolve issues.

Skills

Credentialing experience

Enrollment processes

Multi-state credentialing knowledge

Communication with providers

Education

Associates degree or equivalent

Tools

PECOS/Medicare platforms

State Medicaid enrollment platforms

Google Workspace

Microsoft Office

Job description

Menlo Ventures is seeking a Credentialing and Enrollment Specialist in the United States to ensure clinicians are properly credentialed and enrolled in payor networks. You will manage credentialing, re-credentialing, and enrollment for physicians and allied providers across MCOs, Medicare and Medicaid, while maintaining records in CAQH and payor portals.

You will collaborate with Clinical Operations, Billing and Contracting teams, report to Licensing and Credentialing Team Lead, and drive timely