Provider Enrollment & Credentialing Specialist

Talent Groups; Philadelphia (Philadelphia County); On-site; USD 52,000 - 70,000; Full time

Job summary

Talent Groups seeks a detail-oriented Provider Enrollment & Credentialing Specialist to manage provider enrollment, re-credentialing, and payer documentation processes. The role ensures provider applications and records are accurate, complete, and submitted on time while complying with payer requirements.

The successful candidate will maintain CAQH, NPPES, ECHO, and NAVINET records, verify licenses, and coordinate with physicians and payers to obtain missing information and renewal attestations.

Qualifications

• 2+ years of experience in provider enrollment, credentialing, insurance verification, billing, or provider relations.
• Knowledge of Medicare and Medicaid policies and healthcare provider operations.
• Experience with CAQH, NPPES, ECHO, and NAVINET preferred.
• Proficiency with Microsoft Word, Excel, and PowerPoint.
• Strong organizational, analytical, critical-thinking, and communication skills.
• High School Diploma/GED required; Associate's Degree preferred.

Responsibilities

• Review and process provider enrollment and re-credentialing applications for accuracy and completeness.
• Collect and verify licenses, certifications, credentials, and other required documentation.
• Follow up with physicians and payers to obtain missing information and track application status.
• Maintain accurate provider information, service locations, ownership details, and credentialing records.
• Monitor credential/license expiration dates and ensure timely renewals and CAQH re-attestation.
• Maintain provider information in CAQH, NPPES, ECHO, and NAVINET systems.
• Communicate with payers to obtain provider participation effective dates and identification numbers.

Skills

Provider enrollment

Credentialing

Insurance verification

Billing

Provider relations

Microsoft Word

Excel

PowerPoint

Organization

Analytical skills

Communication skills

Education

High School Diploma/GED

Associate's Degree preferred

Tools

CAQH

NPPES

ECHO

NAVINET

Job description

Talent Groups seeks a detail-oriented Provider Enrollment & Credentialing Specialist to manage provider enrollment, re-credentialing, and payer documentation processes. The role ensures provider applications and records are accurate, complete, and submitted on time while complying with payer requirements.

The successful candidate will maintain CAQH, NPPES, ECHO, and NAVINET records, verify licenses, and coordinate with physicians and payers to obtain missing information and renewal attestations.