Provider Enrollment Specialist: Credentialing & Payor

SCP Health; Lafayette (LA); On-site; USD 18,000 - 26,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision insurance

401(k) plan with company match

Paid time off and holidays

Professional development support

Job summary

SCP Health in Lafayette, LA seeks a Provider Enrollment/Payor Credentialing Specialist to process and maintain provider enrollments with Medicare, Medicaid, BCBS and Commercial payors. You will manage multiple submissions, update CAQH data, and ensure credentials are current, acting as the main liaison with payors.

The role requires 3+ years in credentialing, knowledge of CAQH/NPPES, CMS rules, and proficient MS Office skills. On-site work at client facilities may be required.

Qualifications

• Work independently utilizing documented processes and automated daily reports generated from database.
• Analyze and compare processes when payor requirements change to propose solutions.
• Manage multiple priorities with strong organizational and time management skills.
• Knowledge of Payor Credentialing processes (Par and Non-Par).
• Knowledge of Provider Credentials and CAQH/NPPES databases.
• Experience with CMS Regulations and guidelines.
• Proficient in Microsoft Office (Word, Excel).
• Strong communication and collaboration abilities.
• Minimum 3 years of Provider Enrollment/Payor Credentialing experience.

Responsibilities

• Process and maintain provider enrollment for Medicare/Medicaid/BCBS/Commercial payors.
• Prioritize and manage multiple enrollments in a deadline-driven environment.
• Update CAQH database information and provider credentials every 90 days.
• Serve as primary contact for providers and payors on enrollment inquiries.
• Document approvals and effective dates in enrollment systems.
• Perform data entry and follow-up on submissions to ensure timely approvals.
• Maintain confidentiality of privileged information.

Skills

Independent work

Process improvement

Organizational skills

CAQH knowledge

Provider credentials

CAQH/NPI databases

CMS regulations

MS Office (Word/Excel)

Team collaboration

Effective communication

3+ years experience

Education

HS Diploma

Healthcare Administration

Business Administration

PESC

CPCS

Tools

Availity

Credentialing software

Enrollment software

Job description

SCP Health in Lafayette, LA seeks a Provider Enrollment/Payor Credentialing Specialist to process and maintain provider enrollments with Medicare, Medicaid, BCBS and Commercial payors. You will manage multiple submissions, update CAQH data, and ensure credentials are current, acting as the main liaison with payors.

The role requires 3+ years in credentialing, knowledge of CAQH/NPPES, CMS rules, and proficient MS Office skills. On-site work at client facilities may be required.