Provider Enrollment & Credentialing Specialist

Physicians' Ally Inc.; Littleton (CO); Hybrid; USD 48,000 - 62,000; Full time

Benefits offered by this job

Health insurance

Paid time off

401(k) matching

Dental insurance

Flexible schedule

Vision insurance

Job summary

Physicians' Ally Inc. is seeking a highly organized Credentialing Specialist to manage provider credentialing, payer enrollment, demographics, and regulatory activities across the United States.

The role supports physician practices and healthcare organizations with CAQH maintenance and enrollment workflows. The position emphasizes attention to detail, strong communication, and the ability to juggle multiple deadlines in a fast-paced environment.

Qualifications

• 2+ years of credentialing, provider enrollment, or healthcare administration experience.
• Proficiency with CAQH, NPPES, Medicare, Medicaid, and payer portals.
• Microsoft Office and web-based applications proficiency.
• Strong organizational, communication, and multitasking skills.
• Detail-oriented with professionalism and confidentiality.

Responsibilities

• Manage provider credentialing, recredentialing, and CAQH maintenance.
• Prepare and track provider enrollments with commercial and government payers.
• Maintain provider demographics, NPPES records, payer rosters, and directory listings.
• Coordinate Medicare, Medicaid, and state licensure applications and renewals.
• Manage hospital privileging, ASC credentialing, and facility affiliations.
• Monitor credentialing deadlines, provider documentation, and regulatory compliance.
• Research and resolve credentialing, enrollment, and payer-related issues.
• Communicate effectively with providers, payers, hospitals, and regulatory agencies.

Skills

Credentialing experience

CAQH maintenance

NPPES processing

Medicare/Medicaid enrollments

Payer portals navigation

Microsoft Office

Communication skills

Tools

Modio credentialing software

Job description

Benefits:

• Health insurance
• Paid time off
• 401(k) matching
• Dental insurance
• Flexible schedule
• Vision insurance

Provider Enrollment & Credentialing Specialist

Location: In-Person/Hybrid
Employment Type: Full-Time or Part-Time
Compensation: Competitive, based on experience

About Physicians' Ally Physicians' Ally is a nationally recognized healthcare consulting firm that provides physician practices, surgery centers, and healthcare organizations with expert credentialing, provider enrollment, payer contracting, and consulting services. For more than 25 years, we have helped independent medical practices navigate the complexities of payer participation, provider enrollment, and practice growth.

We are seeking a highly organized and detail-oriented Credentialing Specialist to join our growing team. This position is ideal for an individual who enjoys problem solving, managing multiple projects, and serving as a trusted resource for healthcare providers and practice administrators.

Position Summary The position is posted as full-time, but does not necessarily require 30-40 hours/week. Also posted as fully remote, but if candidate is in Colorado, could be in‑person or hybrid. Responsible for managing provider credentialing, payer enrollment, demographic maintenance, and related regulatory activities on behalf of physician practices across the United States. This role requires strong attention to detail, excellent communication skills, and the ability to work independently while managing multiple deadlines and priorities. Successful candidates will have experience with provider credentialing, CAQH maintenance, Medicare and Medicaid enrollments, payer portals, and healthcare regulatory requirements.

Essential Responsibilities

• Manage provider credentialing, recredentialing, and CAQH maintenance.
• Prepare and track provider enrollments with commercial and government payers.
• Maintain provider demographics, NPPES records, payer rosters, and directory listings.
• Coordinate Medicare, Medicaid, and state licensure applications and renewals.
• Manage hospital privileging, ASC credentialing, and facility affiliations.
• Monitor credentialing deadlines, provider documentation, and regulatory compliance.
• Research and resolve credentialing, enrollment, and payer‑related issues.
• Communicate effectively with providers, payers, hospitals, and regulatory agencies.

Qualifications

Required

• 2+ years of credentialing, provider enrollment, or healthcare administration experience.
• Working knowledge of CAQH, NPPES, Medicare, Medicaid, and payer portals.
• Proficiency with Microsoft Office and web‑based applications.
• Strong organizational, communication, and multitasking skills.
• Detail‑oriented with a high level of professionalism and confidentiality.

Preferred

• CPCS certification.
• Experience with Modio or similar credentialing software.
• Hospital privileging experience.
• Healthcare consulting or multi‑specialty practice experience.