Provider Credentialing & Enrollment Expert

Prestige Healthcare Resources Inc; Washington (District of Columbia); On-site; USD 48,000 - 52,000; Full time

Job summary

Prestige Healthcare Resources, Inc. (PHRI) seeks a Credentialing & Provider Enrollment Specialist to manage end-to-end credentialing for clinicians and organizational enrollment with DC Medicaid, Maryland Medicaid, MCOs, PECOS, and commercial payers.

You will verify licenses, maintain CAQH ProView/NPPES records, track renewals, and coordinate with Billing and AI initiatives to improve data integrity and revenue-cycle operations.

Qualifications

• At least 3 years of credentialing or provider enrollment experience, including Medicaid experience.
• Hands-on experience with CAQH ProView, NPPES, PECOS, and payer portals.
• Knowledge of DC/MD licensure requirements for behavioral health professionals.
• Strong spreadsheet, database, and record-management skills with an EHR/credentialing system.
• Ability to manage multiple applications and renewal cycles with attention to detail.

Responsibilities

• Verify professional licenses, certifications, education, and work history before a clinician’s first assignment.
• Conduct and document required exclusion and sanction screenings (OIG LEIE, SAM.gov, state lists, NPDB).
• Maintain complete, audit-ready credentialing files for clinicians and contractors.
• Manage initial enrollment, recredentialing, revalidation, and demographic updates across Medicaid, PECOS, and payers.
• Maintain CAQH ProView profiles and ensure NPIs, taxonomies, and locations align with payer records.
• Track applications from submission through approval with timely follow-up.

Skills

Credentialing

Provider enrollment

Attention to detail

Regulatory compliance

Data integrity

Education

Bachelor’s degree

Tools

CAQH ProView

NPPES

PECOS

Payer enrollment portals

Job description

Prestige Healthcare Resources, Inc. (PHRI) seeks a Credentialing & Provider Enrollment Specialist to manage end-to-end credentialing for clinicians and organizational enrollment with DC Medicaid, Maryland Medicaid, MCOs, PECOS, and commercial payers.

You will verify licenses, maintain CAQH ProView/NPPES records, track renewals, and coordinate with Billing and AI initiatives to improve data integrity and revenue-cycle operations.