Remote Provider Enrollment Specialist II (Credentialing)

Northern Light Health; Brewer (ME); Remote; USD 58,082,371 - 88,541,107; Full time

Job summary

Northern Light Health is seeking a Provider Enrollment Specialist II to perform provider and facility enrollment and re-credentialing for contracted payers. You will support CAQH profiles, collaborate with revenue cycle, and monitor enrollment gaps and held claims to ensure timely action in alignment with NCQA standards.

Responsibilities include submitting enrollment applications, obtaining required forms, and managing provider demographics within enrollment systems while resolving issues and

Qualifications

• The candidate should have experience in provider enrollment and re-credentialing processes.
• Familiarity with payer enrollment requirements and related documentation is preferred.

Responsibilities

• Manage provider enrollment applications to ensure timely submission.
• Coordinate with credentialing staff and hospital leadership for required forms and signatures.
• Identify payer prerequisites and ensure accurate documentation for enrollment.
• Update provider IDs and enrollment dates to enable timely claims release.
• Troubleshoot enrollment rejections and delays with payers.

Skills

Enrollment management

Re-credentialing

Issue resolution

CAQH profiles

Provider demographics

Tools

CAQH Proview

PECOS

Availity

MIMHS

Job description

Northern Light Health is seeking a Provider Enrollment Specialist II to perform provider and facility enrollment and re-credentialing for contracted payers. You will support CAQH profiles, collaborate with revenue cycle, and monitor enrollment gaps and held claims to ensure timely action in alignment with NCQA standards.

Responsibilities include submitting enrollment applications, obtaining required forms, and managing provider demographics within enrollment systems while resolving issues and