Provider Credentialing & Enrollment Expert

Prestige-Healthcare-Resources-Inc; Washington (District of Columbia); On-site; USD 32,000 - 34,000; Full time

Job summary

Prestige Healthcare Resources, Inc. in Washington, DC seeks a Credentialing & Provider Enrollment Specialist to own end-to-end credentialing and enrollment for clinicians and the organization, ensuring records are accurate, licenses current, and enrollments move from submission to approval.

The role collaborates with Billing, Compliance, Clinical Operations, and the AI transformation team to improve provider data quality and revenue-cycle workflows, with emphasis on accuracy and regulatory

Qualifications

• At least 3 years of credentialing or provider enrollment experience, including Medicaid/Medicaid MCOs.
• Hands-on experience with CAQH ProView, NPPES, PECOS, and payer enrollment portals.
• Working knowledge of DC/Maryland licensure requirements for behavioral health professionals.

Responsibilities

• Verify licenses, certifications, education, and work history before first assignment.
• Conduct exclusion and sanction screenings at hire and monthly (OIG LEIE, SAM.gov, state lists, NPDB as required).
• Maintain audit-ready credentialing files for clinicians and contractors.
• Identify missing or inconsistent documentation and coordinate timely resolution.
• Manage initial enrollment, recredentialing, revalidation, and updates across Medicaid programs, PECOS, and commercial payers.
• Maintain CAQH ProView profiles and required attestations.
• Ensure alignment of NPIs, taxonomies, and practice locations with payer records.
• Track applications from submission through approval and follow-up until resolution.

Skills

Credentialing

Provider enrollment

Medicaid enrollment

NPPES

CAQH ProView

Payer portals

Data integrity

HIPAA compliance

Detail-oriented

Education

Bachelor's degree in healthcare administration or related field

Tools

CAQH ProView

NPPES

PECOS

Credible

Payer portals

EHR system

Job description

Prestige Healthcare Resources, Inc. in Washington, DC seeks a Credentialing & Provider Enrollment Specialist to own end-to-end credentialing and enrollment for clinicians and the organization, ensuring records are accurate, licenses current, and enrollments move from submission to approval.

The role collaborates with Billing, Compliance, Clinical Operations, and the AI transformation team to improve provider data quality and revenue-cycle workflows, with emphasis on accuracy and regulatory