Provider Credentialing & Enrollment Specialist

Jobot; Albuquerque (NM); On-site; USD 50,000 - 60,000; Full time

Job summary

Jobot seeks a Credentialing & Enrollment Specialist in Albuquerque, NM to coordinate initial credentialing, recredentialing, and payer enrollment for physicians and other providers, ensuring they remain credentialed and eligible to bill.

The role requires meticulous organization, ability to manage multiple files and deadlines, and collaboration with Billing, HR, Compliance, and clinical leadership to resolve issues.

Qualifications

• Previous experience with healthcare credentialing, provider enrollment, medical staff services or a closely related healthcare administrative function.
• Experience with Medicare, Medicaid, and/or commercial payer enrollment strongly preferred.
• Knowledge of CAQH and electronic provider enrollment systems preferred.
• Familiarity with New Mexico Medicaid enrollment is highly desirable.
• Understanding of provider licensing, certifications, DEA registrations, malpractice coverage, and credentialing documentation.
• Strong organizational skills and exceptional attention to detail.

Responsibilities

• Coordinate initial credentialing and recredentialing for physicians, advanced practice providers, behavioral health professionals, and other applicable healthcare providers.
• Complete and submit provider enrollment applications with Medicare, New Mexico Medicaid, commercial insurance plans, and other third-party payers.
• Maintain and update provider information within CAQH and other payer or credentialing systems.
• Track credentialing and enrollment applications from initial submission through approval.
• Follow up with insurance carriers and other organizations regarding outstanding applications, documentation, and enrollment status.
• Maintain accurate provider credentialing files and databases.
• Verify and monitor professional licenses, board certifications, DEA registrations, malpractice coverage, and other required credentials.
• Track expiration and renewal dates and proactively obtain updated documentation.
• Assist providers with completing applications, obtaining signatures, and submitting required documentation.
• Coordinate provider additions, terminations, demographic changes, and other updates with insurance carriers.
• Support provider onboarding by ensuring credentialing and payer enrollment requirements are completed accurately and efficiently.
• Work closely with Billing, Human Resources, Compliance, clinic leadership, and providers to resolve credentialing or enrollment issues.
• Maintain confidentiality of provider and organizational information.
• Assist with audits and ensure credentialing documentation remains complete, accurate, and compliant.
• Identify delays or discrepancies that could impact provider enrollment or reimbursement and work proactively toward resolution.

Skills

Credentialing experience

Enrollment coordination

Attention to detail

Communication skills

Microsoft Office

Tools

CAQH

Electronic enrollment systems

Job description

Jobot seeks a Credentialing & Enrollment Specialist in Albuquerque, NM to coordinate initial credentialing, recredentialing, and payer enrollment for physicians and other providers, ensuring they remain credentialed and eligible to bill.

The role requires meticulous organization, ability to manage multiple files and deadlines, and collaboration with Billing, HR, Compliance, and clinical leadership to resolve issues.