Payer Enrollment & Credentialing Specialist

Job Title: Payer Enrollment & Credentialing Specialist

Position Type: Full-Time

Work Hours: 9:00 AM – 6:00 PM PDT

Work Days: Monday to Friday
Salary: $5–$6 per hour, depending on experience
Workplace: Remote

Job Overview

Our client is seeking an experienced and detail-oriented Payer Enrollment & Credentialing Specialist to support a healthcare organization with provider credentialing, payer enrollment, re-credentialing, and ongoing provider compliance.

This role will primarily focus on ensuring healthcare providers are properly credentialed and successfully enrolled with insurance payers. You will be responsible for preparing and submitting enrollment applications, maintaining provider information, following up with insurance companies, tracking application statuses, and ensuring credentials and supporting documentation remain accurate and current.

The ideal candidate has hands-on experience with payer enrollment and provider credentialing and understands how to independently manage applications from initial submission through approval. Strong organization, persistence, accuracy, and follow-up skills are essential, as you will be managing multiple providers, payers, deadlines, and application statuses simultaneously.

Key Responsibilities

Payer Enrollment

• Prepare, complete, and submit provider enrollment applications to commercial insurance payers, Medicare, Medicaid, and other applicable health plans.
• Manage payer enrollment applications from initial submission through approval and effective date.
• Follow up directly with insurance companies regarding pending applications, missing documentation, corrections, and enrollment status.
• Respond promptly to payer requests for additional information or documentation.
• Track application submissions, reference numbers, effective dates, payer decisions, and outstanding requirements.
• Assist with payer-related updates such as demographic changes, practice location updates, provider additions, terminations, and other enrollment maintenance.
• Identify enrollment delays or issues and proactively work with payers and internal teams toward resolution.
• Maintain accurate records of provider participation and payer enrollment status.

Provider Credentialing & Recredentialing

• Manage initial credentialing and re-credentialing requirements for healthcare providers.
• Collect, review, organize, and maintain provider credentialing documents.
• Verify provider information, including NPI, licenses, certifications, education, work history, malpractice coverage, and other required credentials.
• Audit provider files for missing, inaccurate, outdated, or expired documentation.
• Monitor expiration and renewal dates and proactively follow up on required documentation.
• Prepare and submit credentialing and re-credentialing applications accurately and within required timelines.
• Maintain complete and audit-ready credentialing files.
• Assist with resolving credentialing discrepancies or incomplete applications.

Provider Data & Application Management

• Maintain accurate provider demographic and professional information across credentialing and payer systems.
• Ensure consistency of provider information across applications, payer portals, and internal records.
• Maintain credentialing and payer enrollment trackers to provide clear visibility into pending, completed, and outstanding applications.
• Document communications and follow-up activities with payers.
• Communicate with providers and internal stakeholders regarding missing documentation, application updates, and enrollment requirements.
• Escalate potential credentialing or enrollment issues when necessary.

Requirements

Experience Requirements

• Hands-on experience with payer enrollment and provider credentialing is strongly preferred.
• Experience completing and submitting healthcare provider enrollment applications.
• Familiarity with commercial payers, Medicare, and/or Medicaid enrollment processes.
• Experience managing credentialing or enrollment applications from submission through approval.
• Experience with provider credentialing documentation, including NPI, professional licenses, certifications, malpractice insurance, and other provider records.
• Experience with initial credentialing and re-credentialing workflows.
• Experience communicating and following up directly with insurance payers regarding application status and outstanding requirements.
• Familiarity with credentialing platforms, payer portals, and provider databases is highly preferred.
• Experience maintaining credentialing/enrollment trackers and managing multiple deadlines simultaneously.
• Previous healthcare administrative or Medical VA experience is preferred.

Skills & Qualifications

• Strong understanding of the difference between provider credentialing and payer enrollment and how the two processes work together.
• Highly organized and detail-oriented, with strong documentation and tracking skills.
• Able to independently follow up on pending applications without requiring constant supervision.
• Strong problem-solving skills when dealing with payer delays, missing documentation, or application discrepancies.
• Excellent written and verbal English communication skills.
• Comfortable communicating professionally with insurance representatives, providers, and internal teams.
• Able to manage multiple providers, payers, applications, and deadlines at the same time.
• Strong commitment to accuracy, confidentiality, and HIPAA compliance.

Basic Requirements

• Must speak and write English clearly and professionally.
• Must have relevant work experience.
• Must be able to provide an NBI Clearance and/or Local Police Clearance before onboarding (mandatory).
• Must be available to attend video meetings with camera on when required.

Technical Requirements

• Computer: Reliable laptop or desktop computer.
• Internet: Stable high-speed internet connection (minimum 25 Mbps).
• Audio: Noise-canceling headset.
• Video: Working webcam for virtual meetings.
• Workspace: Quiet and professional work environment.

Benefits

• Dedicated HR & Contractor Support Team: Access to world-class support for questions, guidance, contract matters, and client communication.
• Premium VPN Access (Optional): A secure VPN license can be provided upon request to enhance privacy and security for client-related tasks.
• HIPAA & Cybersecurity Training + Certification (Provided): Access to our internal HIPAA compliance training, cybersecurity modules, and certification to help you confidently handle PHI for U.S. healthcare clients.
• Top 1% VA Performance Training: Access to our proprietary training on communication, client management, productivity systems, and best practices to help you become a top-performing VA and increase long-term client retention.
• Client-Approved U.S. Holidays: Contractors may take U.S. holidays off according to the client’s needs and schedule.
• Client-Approved Paid or Unpaid Time Off: Time off may be granted by your client. Paid time off is optional and only if offered by the client.
• Access to Tools & Resources: Templates, workflow guides, productivity tools, and client-specific SOP support to help you perform at your best.
• Optional Performance-Based Incentives: Some clients may offer bonuses, incentives, or increased hours based on your performance.

These are optional resources and client-approved allowances available to you as an independent contractor. Any resources, training, or allowances listed are optional contractor perks and not employee benefits.

Originally posted on Himalayas