Physician Credentialing & Enrollment Specialist

Critical Care Pulmonary and Sleep Associates; Lakewood (CO); On-site; USD 30,000 - 41,000; Full time

Benefits offered by this job

Medical benefits

Dental and vision benefits

PTO and holidays

401k with company contribution

Life and AD&D insurance

Job summary

Critical Care, Pulmonary and Sleep Associates seeks a Physician Enrollment & Credentialing Specialist to manage credentialing, enrollment, appointment, and privileging across commercial payers, government programs, and hospitals in the Denver metro area.

The role also supports revenue cycle operations through researching, appealing, and resolving claim denials and maintaining accurate provider records to ensure timely reimbursement and uninterrupted patient care.

Qualifications

• Two years of provider credentialing or payer enrollment experience.
• Experience with hospital credentialing and privileging preferred.
• Experience researching, appealing, and resolving insurance claim denials preferred.
• Working knowledge of medical terminology and payer guidelines.
• Proficient in MS Office and payer portals.
• Strong communication and customer service skills.

Responsibilities

• Credentialing, enrollment, appointment, and privileging across payers and hospitals.
• Maintain credentialing records and ensure NCQA, TJC, CMS compliance.
• Coordinate onboarding, hospital applications, and maintenance activities.
• Research, appeal, and resolve claim denials to support timely reimbursement.
• Educate team on payer updates and process improvements.
• Support revenue cycle operations and provider data integrity.

Skills

Analytical thinking

Organizational skills

Problem solving

Communication skills

Customer service

Multitasking

Education

High School Diploma or GED

Tools

EPIC Resolute Professional Billing

Microsoft Outlook

Microsoft Word

Microsoft Excel

Job description

Critical Care, Pulmonary and Sleep Associates seeks a Physician Enrollment & Credentialing Specialist to manage credentialing, enrollment, appointment, and privileging across commercial payers, government programs, and hospitals in the Denver metro area.

The role also supports revenue cycle operations through researching, appealing, and resolving claim denials and maintaining accurate provider records to ensure timely reimbursement and uninterrupted patient care.