Senior Credentialing & Payer Enrollment Specialist

Palm Beach Accountable Care Organization; Palm Springs (CA); On-site; USD 65,000 - 85,000; Full time

Job summary

Palm Beach Accountable Care Organization is seeking an experienced Credentialing Specialist to own provider credentialing and payer enrollment from onboarding to recredentialing. Youll work with Administration, Billing, HR, and Compliance to ensure every provider is credentialed, enrolled, and linked to the correct locations and tax entities so patients are seen and claims are paid on time.

Join a growing multispecialty practice focused on Primary Care and Podiatry, with opportunities to improve

Qualifications

• 2–3+ years of medical provider credentialing and payer enrollment experience.
• Strong knowledge of Medicare PECOS, NPPES/NPI, CAQH, and Florida Medicaid enrollment.
• Familiarity with taxonomy codes, group/individual NPIs, TIN affiliations, reassignment, and payer effective dates.
• Knowledge of NPDB, OIG/SAM exclusion screening, and licensure/DEA verification.
• Experience with South Florida/Palm Beach County payer market preferred.
• Multispecialty group, Primary Care, or Podiatry credentialing experience a plus.
• AthenaOne/Athenahealth experience a plus.
• Proficiency with Excel, Microsoft Office, payer portals, and credentialing databases.

Responsibilities

• Submit and follow through on credentialing and enrollment applications with Medicare, Medicaid, and commercial payers.
• Maintain CAQH profiles, NPPES/NPI records, and payer portal data.
• Coordinate onboarding and early payer enrollment to minimize billing delays.
• Track licenses, DEA certificates, malpractice, certifications; perform primary-source verification.
• Manage provider additions, terminations, and demographic changes; roster reconciliation.
• Work with Billing to resolve credentialing-related claim denials.
• Maintain credentialing tracking system and provide status reports.
• Identify new payer/network opportunities to expand access.

Skills

Credentialing

Payer enrollment

PECOS knowledge

NPPES/NPI knowledge

CAQH enrollment

Licensure verification

Audit-ready files

Excel / Office

Payer portals

Relationship management

Athenahealth experience

Tools

Athenahealth

Job description

Palm Beach Accountable Care Organization is seeking an experienced Credentialing Specialist to own provider credentialing and payer enrollment from onboarding to recredentialing. Youll work with Administration, Billing, HR, and Compliance to ensure every provider is credentialed, enrolled, and linked to the correct locations and tax entities so patients are seen and claims are paid on time.

Join a growing multispecialty practice focused on Primary Care and Podiatry, with opportunities to improve