Provider Credentialing & Contracting Specialist

Alicohealthcare; Northern (KY); Hybride; USD 60 000 - 85 000; Plein temps

Résumé du poste

Alicohealthcare is seeking a Provider Credentialing & Contracting Specialist to coordinate enrollment, maintain credentialing records and follow up with payers to prevent billing disruptions.

You will manage CAQH profiles, track contract structures, and escalate enrollment issues to ensure real-time visibility for billing teams.

Qualifications

• 3+ years of healthcare credentialing, provider enrollment, or payer contracting experience.
• Experience using CAQH, PECOS, and commercial payer enrollment portals.
• Experience maintaining accurate provider records and preventing enrollment issues from impacting billing.

Responsabilités

• Coordinate provider and location enrollment and credentialing submissions.
• Track requirements and follow up with commercial payers, Medicare PECOS, and Medicaid.
• Maintain CAQH profiles and provider rosters to prevent enrollment edits.
• Track payer contract structures and fee schedules to support variance reporting.
• Escalate stalled payer enrollments and contact payer representatives to resolve issues.

Connaissances

Credentialing experience

Payer communications

CAQH/PECOS navigation

Outils

CAQH

PECOS

Payer portals

Description du poste

Provider Credentialing & Contracting Specialist

About the role

Coordinate provider and location enrollment, maintain credentialing records, and follow up with payers on outstanding requirements before they affect billing.

Responsibilities

Prepare credentialing and re-credentialing submissions, track requirements, and follow up with commercial payers, Medicare (PECOS), and Medicaid.

Maintain strict accuracy of CAQH profiles and provider rosters to prevent "provider not enrolled" claim edits.

Track payer contract structures, fee schedules, and linked facility locations to support accurate expected-versus-paid variance reporting.

Actively manage escalation paths for stalled payer enrollments, directly contacting payer representatives to resolve application exceptions.

Audit and update internal systems to ensure billing teams have real-time visibility into effective dates and network participation status.

Qualifications

3+ years of experience in healthcare credentialing, provider enrollment, or payer contracting for multi-specialty groups or facilities.

Experience using CAQH, PECOS, and navigating complex commercial payer enrollment portals.

Experience maintaining accurate provider records and resolving payer enrollment issues before they affect billing.

Working arrangements

Location: Remote (Strictly limited to MA, FL, CT, PA, Montreal or NC residents)