Provider Enrollment & Credentialing Specialist

Jobtailor; Lafayette (LA); On-site; USD 42,000 - 62,000; Full time

Job summary

Jobtailor is seeking a Provider Enrollment Specialist in Lafayette, LA to process and manage provider enrollment/applications across Medicare, Medicaid, BCBS, and commercial payors. You will prioritize multiple submissions, maintain CAQH/provider credentials, and serve as the primary point of contact for providers and payors.

The role requires 3+ years in provider enrollment/credentialing, strong organizational skills, and proficiency with CAQH, CMS regulations, and Availity.

Qualifications

• Minimum 3 years of Provider Enrollment/Payor Credentialing experience required.
• Ability to work independently with little or no oversight.
• Ability to analyze changed payor requirements and recommend process solutions.
• Strong organizational and time management skills.
• Knowledge of Payor Credentialing processes, both Par and Non-Par.
• Knowledge of Provider Credentials.
• Experience working in CAQH and National Provider Identifier databases.
• Knowledge of CMS Regulations and guidelines.
• Proficiency in Microsoft Word and Excel.
• Strong interpersonal, oral, and written communication skills.
• Ability to work effectively with diverse constituencies.
• High school diploma required.
• PESC and CPCS certifications preferred.
• Experience with Availity and other provider credentialing/enrollment databases preferred.
• Experience with Medicare, Medicaid, or Commercial payors preferred.
• Experience with credentialing/enrollment software preferred.

Responsibilities

• Process and maintain provider applications for enrollment and re-enrollment for Medicare, Medicaid, BCBS, and Commercial payors.
• Prioritize and manage multiple enrollments in a deadline-driven environment.
• Distribute, log, receive, and scan Provider Enrollment Packets.
• Update National Provider Database information and maintain provider credentials.
• Monitor medical licenses and DEA credentials to ensure they remain active and in good standing.
• Serve as the primary contact for providers and payors regarding enrollment and re-enrollment.
• Identify provider eligibility issues for Government plans and advise management.
• Procure required provider documents and escalated non-responsive providers.
• Enter applications and enrollment documentation into provider databases.
• Follow up on submissions via online, email, or phone to ensure timely approval.
• Monitor Provider Enrollment AR on Hold reports and resolve issues.
• Assist with roster maintenance and training with global partners.
• Update databases for implementation changes.
• Solve enrollment-related issues using critical and strategic thinking.
• Maintain accurate database information and perform data-quality cleanup.
• Maintain confidentiality of privileged information.
• Work in the CAQH database and update provider credentials every 90 days.
• Occasionally be onsite at a client facility to distribute PEPs and facilitate in-person enrollment.
• Document payor approvals and effective dates so information is pushed to the Billing System.
• Monitor payor requirement changes and communicate them to managers.

Skills

Provider Enrollment

Payor Credentialing

CAQH Proficiency

National Provider ID

CMS Regulations

Education

High School Diploma

Tools

Availity

Microsoft Word

Provider Enrollment Databases

Microsoft Excel

Job description

Jobtailor is seeking a Provider Enrollment Specialist in Lafayette, LA to process and manage provider enrollment/applications across Medicare, Medicaid, BCBS, and commercial payors. You will prioritize multiple submissions, maintain CAQH/provider credentials, and serve as the primary point of contact for providers and payors.

The role requires 3+ years in provider enrollment/credentialing, strong organizational skills, and proficiency with CAQH, CMS regulations, and Availity.