Provider Credentialing & Enrollment Specialist

American Advanced Management; Modesto (CA); On-site; USD 30,000 - 36,000; Full time

Job summary

American Advanced Management is seeking a Provider Enrollment Specialist to manage the credentialing workflow for healthcare providers with insurance plans and government payers. You will prepare enrollment packets, verify credentials, and coordinate with payers to resolve issues efficiently.

You will maintain provider data in CAQH and other systems, ensure accuracy of licenses and addresses, and support compliance with applicable regulations.

Qualifications

• Strong understanding of healthcare regulations and payer requirements.
• Experience with provider enrollment software and CAQH.
• 3–5 years in credentialing, managed care, or claims processing.
• Excellent attention to detail and strong organizational and communication skills.

Responsibilities

• Prepare and submit enrollment applications and supporting documents for new and existing providers.
• Maintain provider information in databases and systems, ensuring accuracy of licenses, certifications, and addresses.
• Verify provider credentials and ensure all paperwork meets the requirements of various health plans and government payers.
• Liaise with providers and payers to expedite the enrollment and re-enrollment process.
• Research and resolve issues that delay enrollment, such as missing information on applications.
• Organize and maintain files for all provider enrollments and related documentation.

Skills

Attention to detail

Organizational skills

Effective communication

Tools

CAQH

Provider enrollment software

Microsoft Word

Microsoft Excel

Job description

American Advanced Management is seeking a Provider Enrollment Specialist to manage the credentialing workflow for healthcare providers with insurance plans and government payers. You will prepare enrollment packets, verify credentials, and coordinate with payers to resolve issues efficiently.

You will maintain provider data in CAQH and other systems, ensure accuracy of licenses and addresses, and support compliance with applicable regulations.