Remote Provider Credentialing & Enrollment Specialist

Critical Care, Pulmonary & Sleep Associates; United States; Remote; USD 34,000 - 55,000; Part time

Benefits offered by this job

Competitive hourly compensation

Part-time with potential for full-time

Job summary

Critical Care, Pulmonary and Sleep Associates is seeking a Physician Enrollment & Credentialing Specialist to manage provider credentialing, enrollment, appointment, and privileging across commercial payers and hospitals. The role supports timely reimbursement and uninterrupted patient care.

The candidate will maintain accurate provider records, ensure NCQA/TJC/CMS standards, and collaborate with providers and insurers to meet regulatory requirements.

Qualifications

• Minimum of two (2) years of experience in provider credentialing and/or payer enrollment preferred.
• Experience with hospital credentialing and privileging strongly preferred.
• Working knowledge of medical terminology, provider taxonomy, commercial and government payer guidelines and credentialing requirements.
• Proficiency in Microsoft Outlook, Word, Excel, internet research, and payer portals.
• High School Diploma or GED required.

Responsibilities

• Ensure CCPSA providers are credentialed, enrolled, appointed, and privileged with commercial and government payers, hospitals, and other healthcare organizations to support uninterrupted clinical operations and timely reimbursement.
• Complete provider enrollment, credentialing, recredentialing, revalidation, appointment, privileging, and ongoing maintenance activities with commercial and government payers, hospitals, and other healthcare organizations.
• Coordinate provider onboarding activities related to credentialing and privileging, including hospital application requirements and other required pre-start activities, as applicable.
• Maintain credentialing records and monitor compliance with licenses, certifications, DEA registrations, malpractice coverage, continuing education, and other credentialing requirements.
• Maintain accurate provider information within credentialing systems, payer portals, hospital credentialing systems, CAQH, and other required databases.
• Ensure all credentialing files meet standards set by the NCQA, TJC, CMS, hospitals, and payer-specific guidelines.
• Serve as the primary point of contact for provider credentialing, enrollment, appointment, and privileging questions.
• Support additional practice operations and administrative functions based on organizational needs, individual interests, and opportunities for professional growth.

Skills

Analytical skills

Organizational skills

Problem-solving

Communication skills

Independent work

Education

High School Diploma or GED

Tools

EPIC Resolute Professional Billing

Job description

Critical Care, Pulmonary and Sleep Associates is seeking a Physician Enrollment & Credentialing Specialist to manage provider credentialing, enrollment, appointment, and privileging across commercial payers and hospitals. The role supports timely reimbursement and uninterrupted patient care.

The candidate will maintain accurate provider records, ensure NCQA/TJC/CMS standards, and collaborate with providers and insurers to meet regulatory requirements.