Provider Enrollment and Credentialing Specialist

About RCM360

RCM360 is a healthcare revenue cycle management organization specializing in medical billing, credentialing, coding, accounts receivable management, and practice optimization services. We partner with healthcare providers across the United States to improve reimbursement, streamline operations, and support long-term financial success.

Position Summary

RCM360 is seeking an experienced and highly organized Provider Enrollment and Credentialing Specialist to support credentialing and enrollment activities for medical providers and healthcare organizations. The Credentialing Specialist will be responsible for managing provider enrollment, recredentialing, payer audits, and maintaining provider data across multiple platforms while ensuring compliance with payer, regulatory, and organizational requirements.

The ideal candidate will have strong knowledge of Medicare, Medicaid, commercial payer credentialing, and provider enrollment processes, along with the ability to manage multiple projects and deadlines in a fast-paced environment.

Primary Responsibilities

• Complete provider credentialing and recredentialing applications for commercial, Medicare, Medicaid, and managed care payers.
• Process provider enrollment, revalidation, and demographic updates with government and commercial payers.
• Maintain accurate provider information in CAQH, PECOS, NPPES, and payer portals.
• Monitor credentialing status and proactively follow up with payers to ensure timely approvals.
• Maintain detailed documentation of credentialing activities within credentialing software and tracking systems.
• Coordinate initial credentialing and ongoing recredentialing with hospitals, surgery centers, and ancillary facilities.
• Verify provider licenses, board certifications, DEA registrations, malpractice insurance, and other required credentials.
• Respond to payer requests for additional documentation and resolve enrollment issues.
• Collaborate with billing, coding, and account management teams to address denials or reimbursement issues related to credentialing.
• Participate in client meetings and provide status updates regarding credentialing projects.
• Stay current with payer guidelines, enrollment requirements, and industry regulations.
• Assist with onboarding new providers and ensure credentialing tasks are completed prior to effective dates.
• Maintain confidentiality and compliance with HIPAA and company policies.

Skills & Abilities

General

• Excellent written and verbal communication skills.
• Strong attention to detail and organizational abilities.
• Ability to manage multiple provider enrollments simultaneously.
• Professional demeanor with strong customer-service orientation.
• Ability to work independently and as part of a team.
• Proficiency with Microsoft Office applications and credentialing software platforms.

Problem Solving

• Identifies and resolves credentialing issues efficiently.
• Research complex payer requirements and enrollment challenges.
• Escalates issues appropriately while maintaining ownership of assigned projects.

Project Management

• Tracks multiple credentialing projects and deadlines simultaneously.
• Provides timely updates to clients and internal stakeholders.
• Maintains accurate reporting and documentation.

Preferred Experience

• Experience with CAQH, PECOS, NPPES, and Medicare enrollment processes.
• Experience working within a Revenue Cycle Management organization.
• Experience with credentialing software platforms.
• Experience working with offshore teams is a plus.
• Familiarity with eClinicalWorks and NextGen healthcare practice management systems is a plus.

Qualifications

• Minimum 2 years of medical credentialing experience required.
• Demonstrated experience credentialing providers with Medicare, Medicaid, and commercial insurance payers.
• Strong understanding of provider enrollment, recredentialing, and payer maintenance processes.
• High school diploma required
• Credentialing certification (CPCS, CPMSM, or equivalent) preferred but not required.

Job Details

• Full-Time
• Remote
• Occasional travel as required for client meetings or training

Key Performance Metrics

• Credentialing applications submitted accurately and on time
• Recredentialing projects completed before payer deadlines
• Provider enrollment turnaround times
• Accuracy of provider records and databases
• Client satisfaction and responsiveness
• Productivity and quality standards achieved

Pay: $45,000.00 - $55,000.00 per year

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Flexible spending account
• Health insurance
• Health savings account
• Life insurance
• Paid time off
• Vision insurance

Work Location: Remote