Physician Enrollment & Credentialing Specialist

Critical Care, Pulmonary & Sleep Associates; United States; Remote; USD 34,000 - 55,000; Part time

Benefits offered by this job

Competitive hourly compensation

Part-time with potential for full-time

Job summary

Critical Care, Pulmonary and Sleep Associates is seeking a Physician Enrollment & Credentialing Specialist to manage provider credentialing, enrollment, appointment, and privileging across commercial payers and hospitals. The role supports timely reimbursement and uninterrupted patient care.

The candidate will maintain accurate provider records, ensure NCQA/TJC/CMS standards, and collaborate with providers and insurers to meet regulatory requirements.

Qualifications

• Minimum of two (2) years of experience in provider credentialing and/or payer enrollment preferred.
• Experience with hospital credentialing and privileging strongly preferred.
• Working knowledge of medical terminology, provider taxonomy, commercial and government payer guidelines and credentialing requirements.
• Proficiency in Microsoft Outlook, Word, Excel, internet research, and payer portals.
• High School Diploma or GED required.

Responsibilities

• Ensure CCPSA providers are credentialed, enrolled, appointed, and privileged with commercial and government payers, hospitals, and other healthcare organizations to support uninterrupted clinical operations and timely reimbursement.
• Complete provider enrollment, credentialing, recredentialing, revalidation, appointment, privileging, and ongoing maintenance activities with commercial and government payers, hospitals, and other healthcare organizations.
• Coordinate provider onboarding activities related to credentialing and privileging, including hospital application requirements and other required pre-start activities, as applicable.
• Maintain credentialing records and monitor compliance with licenses, certifications, DEA registrations, malpractice coverage, continuing education, and other credentialing requirements.
• Maintain accurate provider information within credentialing systems, payer portals, hospital credentialing systems, CAQH, and other required databases.
• Ensure all credentialing files meet standards set by the NCQA, TJC, CMS, hospitals, and payer-specific guidelines.
• Serve as the primary point of contact for provider credentialing, enrollment, appointment, and privileging questions.
• Support additional practice operations and administrative functions based on organizational needs, individual interests, and opportunities for professional growth.

Skills

Analytical skills

Organizational skills

Problem-solving

Communication skills

Independent work

Education

High School Diploma or GED

Tools

EPIC Resolute Professional Billing

Job description

Company & Position Summary:

Critical Care, Pulmonary and Sleep Associates is a multispecialty private physician practice, providing Critical Care, Pulmonary and Sleep medical services to the Denver metro area for over 40 years. Our dedicated team of Board-Certified Critical Care, Pulmonary and Sleep Physicians along with our skilled clinical and administrative staff exclusively serve nine Common Spirit and AdventHealth Hospital ICU’s and multiple outpatient clinic locations spanning Colorado’s front range. CCPSA’s organizational culture exemplifies excellence in patient centered care, unified teamwork, and a highly collaborative approach in all business and clinical operations. We are currently seeking a Physician Enrollment & Credentialing Specialist to join our committed team of professionals.

The Physician Enrollment & Credentialing Specialist is primarily responsible for provider credentialing, enrollment, appointment, and privileging across commercial insurance payers, government programs, hospitals, and other healthcare organizations. This position ensures providers are appropriately credentialed, enrolled, appointed, and privileged to support timely reimbursement and uninterrupted patient care. The individual in this role partners with providers, internal teams, hospitals, and insurance carriers to maintain accurate provider records, meet credentialing and regulatory requirements, and support efficient clinical and business operations. This role requires commitment to the CCPSA culture of collaboration while identifying opportunities for continuous improvement and supporting the organization's shared values.

Work Location & Schedule:

• This position is available on a part-time basis, with the potential for full-time employment depending on candidate interest and operational needs. Additional responsibilities may be incorporated to support other practice operations and administrative functions.
• This position is primarily remote; however, candidates must reside in the Denver metropolitan area to accommodate occasional in-office meetings, training, and other practice needs.

Essential Responsibilities and Tasks:

• Ensure CCPSA providers are credentialed, enrolled, appointed, and privileged with commercial and government payers, hospitals, and other healthcare organizations to support uninterrupted clinical operations and timely reimbursement.
• Complete provider enrollment, credentialing, recredentialing, revalidation, appointment, privileging, and ongoing maintenance activities with commercial and government payers, hospitals, and other healthcare organizations.
• Coordinate provider onboarding activities related to credentialing and privileging, including hospital application requirements and other required pre-start activities, as applicable.
• Maintain credentialing records and monitor compliance with licenses, certifications, DEA registrations, malpractice coverage, continuing education, and other credentialing requirements.
• Maintain accurate provider information within credentialing systems, payer portals, hospital credentialing systems, CAQH, and other required databases.
• Ensure all credentialing files meet standards set by the NCQA, TJC, CMS, hospitals, and payer-specific guidelines.
• Serve as the primary point of contact for provider credentialing, enrollment, appointment, and privileging questions.
• Support additional practice operations and administrative functions based on organizational needs, individual interests, and opportunities for professional growth.

Skills, Education and/or Work Experience Requirements:

• Minimum of two (2) years of experience in provider credentialing and/or payer enrollment preferred.
• Experience with hospital credentialing and privileging strongly preferred.
• Working knowledge of medical terminology, provider taxonomy, commercial and government payer guidelines and credentialing requirements.
• Excellent analytical, organizational, problem-solving, and critical thinking skills.
• Demonstrated commitment to exceptional customer service through professional communication, responsiveness, and timely follow-up.
• Ability to work independently while effectively managing multiple competing priorities and consistently meeting deadlines.
• Strong written and verbal communication skills.
• Proficiency in Microsoft Outlook, Word, Excel, internet research, and payer portals.
• Experience with EPIC Resolute Professional Billing strongly preferred.
• High School Diploma or GED required.

Compensation & Benefits:

• Competitive hourly compensation.
• Position available on a part-time basis, with the potential for full-time employment depending on candidate interest and operational needs.

Full-time employees are eligible for the following benefits:

• Benefits effective date of hire (no waiting period).
• Comprehensive medical benefits. Company covers 80–85% of individual or family premiums.
• Dental and vision benefits offered at no cost to the employee. Company covers 100% of individual or family premiums.
• Life and AD&D benefits.
• Optional additional life and disability insurance at group discounts.
• PTO and holiday pay.
• 401(k) benefits with company contribution after eligibility period.