Remote Credentialing & Enrollments Specialist

Modena Health; Northern (KY); Hybrid; USD 37,000 - 47,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision insurance

401(k) with employer matching

PTO & holidays

Professional development

Job summary

Modena Health is seeking a Credentialing and Enrollments Specialist to manage credentialing, payer enrollment, and provider onboarding for physicians and APPs. The role supports uninterrupted billing and patient care, emphasizing accuracy, deadlines, and HIPAA compliance.

The position is full-time and remote with a preference for candidates in CA, AZ, CO, NM, or SC. Candidates should have 2+ years in credentialing and be proficient with CAQH, PECOS, NPPES, and CredentialStream.

Qualifications

• Minimum of 2 years of experience in provider credentialing, payer enrollment, medical staff services, or healthcare administration required.
• Experience with commercial and government payer enrollment processes strongly preferred.
• Working knowledge of CAQH, PECOS, NPPES, and payer enrollment portals required.
• Experience maintaining provider records and credentialing databases, including CredentialStream or similar credentialing software.
• Experience with hospital privileging and provider onboarding preferred.

Responsibilities

• Prepare, submit, and manage provider credentialing and payer enrollment applications for commercial, Medicare, Medicaid, and other health plans.
• Coordinate initial credentialing, recredentialing, and provider data maintenance processes for physicians and advanced practice providers.
• Maintain accurate and up-to-date provider files, including CAQH profiles, NPI information, state licenses, DEA certificates, malpractice insurance, board certifications, and other required documentation.
• Maintain all credentialing, enrollment, and contracting records within CredentialStream and other designated databases.
• Monitor credentialing and enrollment statuses through payer portals and follow up regularly to ensure timely approvals.
• Track expiration dates for licenses, certifications, malpractice coverage, and other required documents to ensure continuous compliance.
• Respond to payer requests for additional documentation or clarification in a timely manner.
• Communicate credentialing and enrollment status updates to leadership, billing managers, clinic managers, providers, and other stakeholders as needed.
• Assist with onboarding new providers, including coordinating credentialing timelines, payer enrollments, and hospital privileging requirements.
• Support provider offboarding activities, including payer terminations and record updates.
• Maintain confidentiality and ensure compliance with HIPAA and organizational policies at all times.

Skills

Attention to detail

Organizational skills

Communication skills

Microsoft Office

EHR systems

Credentialing portals

Education

High school diploma or equivalent

Associate degree or higher preferred

Tools

CredentialStream

CAQH

PECOS

NPPES

Job description

Modena Health is seeking a Credentialing and Enrollments Specialist to manage credentialing, payer enrollment, and provider onboarding for physicians and APPs. The role supports uninterrupted billing and patient care, emphasizing accuracy, deadlines, and HIPAA compliance.

The position is full-time and remote with a preference for candidates in CA, AZ, CO, NM, or SC. Candidates should have 2+ years in credentialing and be proficient with CAQH, PECOS, NPPES, and CredentialStream.