provider enrollment specialist

Top Line Resource Group (TLRG)

Location: DHA phase 8, Lahore (Onsite) Work Schedule: 05PM &ndash; 02AM Pakistan Time Employment Type: Full-time (Night Shift)Topline Resource Group (TLRG) is looking for a knowledgeable Credentialing and Enrollment Specialist to support the provider onboarding process and maintain payer credentialing records. This role focuses on ensuring healthcare providers are successfully enrolled with insurance carriers and that all credentialing documentation remains current and compliant with industry standards.The successful candidate will play an important role in coordinating credentialing activities, maintaining provider records, and communicating with payers to ensure smooth enrollment and approval processes.Core Responsibilities<ul><li>Handle the enrollment process for healthcare providers with insurance payers including Commercial plans, Medicare, Medicaid, and other specialty networks.</li><li>Maintain comprehensive credentialing documentation, ensuring records such as licenses, certifications, DEA registration, NPI information, and CAQH profiles remain accurate and updated.</li><li>Prepare and submit credentialing applications for new provider enrollment, renewals, and information updates with insurance carriers.</li><li>Monitor the progress of submitted applications and follow up with payers to facilitate timely processing and approvals.</li><li>Ensure all credentialing procedures comply with industry standards and payer policies, including NCQA and URAC requirements.</li><li>Review and validate provider documentation to confirm all credentialing criteria and regulatory standards are met.</li><li>Collaborate with internal departments such as Human Resources, Compliance, and Billing to support provider onboarding and credentialing updates.</li><li>Address credentialing discrepancies, assist with payer inquiries, and resolve enrollment-related issues when they arise.</li><li>Maintain organized records and generate reports related to provider enrollment and credentialing activities.</li></ul>Required Experience &amp; Qualifications<ul><li>Minimum 2&ndash;3 years of professional experience in provider enrollment and credentialing within the healthcare industry.</li><li>Strong understanding of U.S. healthcare insurance systems and credentialing workflows.</li><li>Working knowledge of credentialing standards including NCQA, URAC, and payer regulations.</li><li>Experience using credentialing platforms and EHR/Practice Management systems.</li><li>Strong organizational skills with the ability to manage multiple assignments efficiently.</li><li>Excellent written and verbal communication abilities.</li><li>High level of accuracy and attention to detail.</li></ul>Preferred Qualifications<ul><li>Experience handling provider enrollment across multiple U.S. states.</li><li>Ability to work independently in a fast-paced, high-volume environment while meeting deadlines.</li><li>Background in Revenue Cycle Management (RCM), medical billing, or healthcare administration is a plus.</li></ul>Pay: Rs80,000.00 - Rs110,000.00 per monthExperience:<ul><li>enrollment and credentialing: 2 years (Preferred)</li></ul>Work Location: In person

Credentialing and Enrollment Executive - (US Healthcare)

Sentara

<div><div><h1 class="jobSectionHeader">Sentara Health is currently hiring for an Enrollment Specialist I- Remote!
</h1><div>Position Status: Full-time, permanent (40 hours)
Standard Working Hours: Monday - Friday, 8:00AM - 5:00PM EST.
Location: Remote in Virginia
Overview
Responsible for all areas of enrollment, group information and researching with response to all inquiries related to member, employer, and eligibility. Provides quality service and customer satisfaction through accurate entry of data and communication to internal and external customers.
Education
<ul><li>High school diploma or equivalent REQUIRED
</li><li>Associate Degree preferred
</li></ul>Certification/Licensure
<ul><li>No specific certification or licensure requirements
</li></ul>Experience
<ul><li>Customer Service - 1 year REQUIRED
</li><li>Health plan or enrollment experience preferred
</li></ul>Sentara Health Plans provides health plan coverage to close to one million members in Virginia. We offer a full suite of commercial products including employee-owned and employer-sponsored plans, as well as Individual &amp; Family Health Plans, Employee Assistance Programs and plans serving Medicare and Medicaid enrollees.
Our quality provider network features a robust provider network, including specialists, primary care physicians and hospitals.
We offer programs to support members with chronic illnesses, customized wellness programs, and integrated clinical and behavioral health services&mdash;all to help our members improve their health.
Our success is supported by a family-friendly culture that encourages community involvement and creates unlimited opportunities for development and growth.
Be a part of an excellent healthcare organization that cares about our People, Quality, Patient Safety, Service, and Integrity. Join a team that has a mission to improve health every day and a vision to be the healthcare choice of the communities that we serve!
To apply, please go to www.sentaracareers.com and use the following as your Keyword Search: JR-98416
Talroo-Health Plan</div></div></div>

Enrollment Specialist I - Remote

VIVO Healthcare

<div>Multi-site coverage required
Department:
Medical Staff Services / Human Resources / Provider Enrollment / Compliance
Position Summary
The Credentialing Specialist is responsible for coordinating, processing, and maintaining all aspects of provider credentialing, recredentialing, licensure verification, and payer enrollment to ensure healthcare professionals meet all organizational, regulatory, state, federal, and payer requirements. This role supports medical records with all record requests and legal requests.
Essential Duties and Responsibilities<ul><li>
Coordinate the initial credentialing and recredentialing process for physicians, nurse practitioners, physician assistants, therapists, and allied health professionals.</li><li>
Verify provider education, training, board certifications, work history, malpractice coverage, state licensure, DEA registration, and professional references through primary source verification.</li><li>
Maintain accurate credentialing files and electronic databases for all licensed practitioners.</li><li>
Monitor expiration dates for licenses, certifications, malpractice insurance, and other required credentials.</li><li>
Ensure timely follow-up with providers regarding missing or expiring documentation.</li><li>
Prepare and submit credentialing applications to hospitals, health plans, Medicare, Medicaid, and commercial insurance carriers.</li><li>
Process provider privileging applications and assist with medical staff appointment documentation.</li><li>
Track application status and resolve delays with regulatory agencies, payers, and accrediting bodies.</li><li>
Prepare credentialing reports, audit logs, and provider status updates for leadership.</li><li>
Assist with credentialing audits, surveys, and accreditation reviews.</li><li>
Collaborate with Human Resources, Medical Staff Office, and Operations departments regarding provider onboarding.</li><li>
Maintain confidentiality of provider and organizational information.</li><li>
Identify opportunities for process improvement within credentialing workflows.</li><li>
Review of all medical record requests</li><li>
Coordinate with the facility for all medical requests for legal review</li><li>
Organize and track all legal record requests</li></ul>
Required Qualifications<ul><li>
Minimum of 2 years of healthcare credentialing, provider enrollment, or medical staff services experience.</li><li>
Knowledge of provider credentialing standards, payer enrollment, and healthcare regulatory compliance.</li><li>
Strong knowledge of Point Click Care, NPDQ, Florida Board</li><li>
Proficiency in Microsoft Office Suite, especially Excel and Word.</li><li>
Excellent organizational, analytical, and follow-up skills.</li><li>
Strong written and verbal communication abilities.</li><li>
Ability to manage multiple deadlines in a fast-paced environment.</li><li>
High level of accuracy and attention to detail.</li></ul>
Preferred Qualifications<ul><li>
Experience with medical staff credentialing.</li><li>
Familiarity with AHCA, CMS, Joint Commission, or survey requirements.</li><li>
Experience in skilled nursing, managed care, physician practice, or multi-site healthcare systems.</li></ul>
Core Competencies<ul><li>
Regulatory Compliance Knowledge</li><li>
Time Management</li><li>
Deadline Tracking</li><li>
Problem Solving</li><li>
Confidentiality</li><li>
Interdepartmental Collaboration</li><li>
Audit Readiness</li><li>
Communication &amp; Follow-up</li></ul>
Work Environment<ul><li>
Office or remote healthcare administrative setting</li><li>
High-volume documentation review and data entry</li><li>
Deadline-driven compliance environment</li></ul>
Physical Requirements<ul><li>
Prolonged sitting and computer use</li><li>
Ability to review detailed documents and maintain records</li><li>
Occasional filing, scanning, and document retrieval</li></ul>
https://info.flclearinghouse.com 
#snfcorp</div>

Credentialing and Medical Records Specialist

Parallon

<div>This Work from Home position requires that you live and will perform the duties of the position; within 60 miles of an HCA Healthcare Hospital (Our hospitals are located in the following states: FL, GA, ID, KS, KY, MO, NV, NH, NC, SC, TN, TX, UT, VA).
Experience the HCA Healthcare difference where colleagues are trusted, valued members of our healthcare team. Grow your career with an organization committed to delivering respectful, compassionate care, and where the unique and intrinsic worth of each individual is recognized. Submit your application for the opportunity below: EDI Enrollment Specialist<h5 class="jobSectionHeader">
Job Summary and Qualifications</h5><h5 class="jobSectionHeader">
Seeking an Electronic Data Interchange (EDI) Enrollment Specialist, who is responsible for applying a fundamental knowledge of healthcare billing practices and procedures related to enrolling providers electronically for claims submission, remittance, and funds transfer. In addition, this team member is responsible for identifying, creating, monitoring, and releasing claim hold rules. This job has regular contact with internal and external customers and requires regular outreach to payers. We are an amazing team that works hard to support each other and are seeking a phenomenal addition like you. We want you to apply today!
What you will do in this role:<ul><li>
Prepare and submit applications to configure Electronic Data Interchange (EDI) claims and Electronic Remittance Advice (ERA) through clearinghouse
</li><li>Prepare and submit applications to configure Electronic Funds Transfer (EFT) with payers
</li><li>Initiate telephone calls to payers with respect to provider enrollment and claim errors, utilizing proper customer service protocol
</li><li>Review correspondence received and perform appropriate action to resolve
</li><li>Manage billing hold rules including identifying, creating, monitoring, and releasing</li><li>
Configure providers in billing system
</li><li>Work as a liaison between Provider Enrollment department and other operational departments Participate in process to establish payer-specific billing edits
</li><li>Meet and maintain established departmental performance metrics for production and quality Maintain working knowledge of workflow, systems, and tools used in the department</li></ul>
What qualifications you will need:
<ul><li>High school diploma or GED preferred</li><li>
Minimum 1 year related healthcare experience preferred, such as EDI, ERA, and EFT configuration, professional medical billing, insurance follow-up, or accounts receivable follow-up. Relevant education may substitute experience requirement</li></ul>
Benefits</h5>
Parallon, offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available plans and programs include:<ul><li>
Comprehensive benefits for medical, prescription drug, dental, vision, behavioral health and telemedicine services</li><li>
Wellbeing support, including free counseling and referral services</li><li>
Time away from work programs for paid time off, paid family leave, long- and short-term disability coverage and leaves of absence</li><li>
Savings and retirement resources, including a 401(k) Plan with a 100% match on 3% to 9% of pay (based on years of service), Employee Stock Purchase Plan, flexible spending accounts, preferred banking partnerships, retirement readiness tools, rollover support and financial wellbeing counseling</li><li>
Education support through tuition assistance, student loan assistance, certification support, dependent scholarships and a partnership with Galen College of Nursing</li><li>
Additional benefits for fertility and family building, adoption assistance, life insurance, supplemental health protection plans, auto and home insurance, legal counseling, identity theft protection and consumer discounts</li></ul>
Learn more about Employee Benefits
Note: Eligibility for benefits may vary by location.
&quot;
Parallon provides full-service revenue cycle management, or total patient account resolution, for HCA Healthcare. Our services include scheduling, registration, insurance verification, hospital billing, revenue integrity, collections, payment compliance, credentialing, health information management, customer service, payroll and physician billing. We also provide full-service revenue cycle management as well as targeted solutions, such as Medicaid Eligibility, for external clients across the country. Parallon has over 17,000 colleagues, and serves close to 1,000 hospitals and 3,000 physician practices, all making an impact on patients, providers and their communities.
HCA Healthcare has been recognized as one of the World&rsquo;s Most Ethical Companies&reg; by the Ethisphere Institute more than ten times. In recent years, HCA Healthcare spent an estimated $3.7 billion in cost for the delivery of charitable care, uninsured discounts, and other uncompensated expenses.
&quot; 
&quot;There is so much good to do in the world and so many different ways to do it.&quot;- Dr. Thomas Frist, Sr. 
HCA Healthcare Co-Founder 
If you find this opportunity compelling, we encourage you to apply for our EDI Enrollment Specialist opening. We promptly review all applications. Highly qualified candidates will be directly contacted by a member of our team. We are interviewing - apply today!
We are an equal opportunity employer. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.</div>

EDI Enrollment Specialist

Macrise Tech Solutions

The Credentialing Specialist is responsible for managing the complete lifecycle of provider credentialing and re-credentialing across various insurance networks, payers, and credentialing platforms. This role requires a proactive, detail-oriented professional with strong follow-up capabilities to ensure ongoing regulatory compliance, uninterrupted provider participation, and efficient billing and authorization workflows. The position plays a critical role in supporting operational efficiency and ensuring accurate, timely reimbursements.Key ResponsibilitiesCredentialing &amp; Compliance<ul><li>Maintain, organize, and regularly update provider credentialing records for both commercial and government payers.</li><li>Oversee and manage CAQH profiles to ensure compliance with CMS regulations and payer-specific credentialing standards.</li><li>Process initial credentialing, re-credentialing, and payer enrollment applications for Medicare, Medicaid, and commercial insurance networks.</li><li>Manage applications, renewals, and documentation related to professional licenses, DEA registrations, and controlled substance certifications.</li><li>Complete provider revalidation processes with government and regulatory bodies within required timelines.</li><li>Coordinate hospital credentialing activities, including managing provider privileges and maintaining active affiliations.</li></ul>Collaboration &amp; Operational Support<ul><li>Work closely with the Revenue Cycle Director and Billing Team to resolve credentialing-related denials, payer concerns, and authorization delays.</li><li>Ensure provider data is accurate and consistent across CAQH, PECOS, NPPES, CMS databases, and internal systems.</li><li>Maintain a centralized credentialing tracker, including provider credentials, expiration dates, payer participation status, and system access information.</li><li>Provide administrative support for credentialing audits, compliance reviews, and regulatory documentation as required</li></ul>Job Type: Full-timePay: Rs45,000.00 - Rs80,000.00 per monthAbility to commute/relocate:<ul><li>Wapda Town: Reliably commute or planning to relocate before starting work (Required)</li></ul>Application Question(s):<ul><li>Willing to work the night shift in Wapda Town, Lahore?</li></ul>Experience:<ul><li>Credentialing: 1 year (Preferred)</li></ul>Language:<ul><li>English (Required)</li></ul>Work Location: In person

Payer Enrollment & Credentialing Specialist

Jawa Health Care

Job Title: Credentialing Expert Department: Credentialing / RCM Industry: Healthcare / DME Experience: 1&ndash;3 years (Fresh + Experienced can apply)Job SummaryWe are looking for a detail-oriented Credentialing Expert to manage provider enrollment, re-credentialing, and compliance with insurance networks. The ideal candidate will ensure timely onboarding of providers and maintain accurate credentialing records.Key Responsibilities<ul><li>Handle provider enrollment with Medicare, Medicaid, and commercial payers</li><li>Manage CAQH profiles (creation, updating, attestation)</li><li>Submit and track credentialing and re-credentialing applications</li><li>Follow up with insurance companies for application status</li><li>Maintain provider documentation (licenses, NPI, DEA, malpractice insurance)</li><li>Ensure compliance with payer requirements and deadlines</li><li>Resolve credentialing-related issues and delays</li><li>Maintain accurate records in credentialing systems</li></ul>Requirements<ul><li>Bachelor&rsquo;s degree (preferred)</li><li>Knowledge of US healthcare credentialing process</li><li>Familiarity with CAQH, PECOS, NPPES</li><li>Strong communication and follow-up skills</li><li>Good command of MS Excel and documentation</li></ul><ul><li>Shift: Night shift (US timing)</li><li>6pm to 3am</li><li>Monday to Friday</li><li>Saturday Sunday off</li><li>Location: On-site</li><li>Salary: Market competitive</li><li>Perks: Growth, training,</li></ul>Job Type: Full-timePay: Rs40,000.00 - Rs50,000.00 per monthWork Location: In person

Credentialing Expert

sequel technologies

Location: Bahria Town Phase 7, Rawalpindi (Preference for residents of Bahria, DHA, or nearby areas)Company Description Sequel Technologies, a software company providing healthcare IT and medical billing services to the US market.Responsibilities<ul><li>Manage end-to-end provider enrollment and credentialing with commercial and government payers (Medicare, Medicaid)</li><li>Prepare, review, and submit enrollment applications and supporting documentation accurately and on time.</li><li>Track application status, follow up with payers, and resolve rejections or delays.</li><li>Maintain and update provider data across EHR, billing, and credentialing systems.</li><li>Handle EDI, ERA, and EFT enrollments with payers and clearinghouses.</li><li>Collaborate with billing and RCM teams to resolve claim denials related to enrollment issues.</li><li>Ensure compliance with payer requirements and regulatory standards (e.g., CMS, HIPAA).</li><li>Maintain credentialing databases (e.g., CAQH, PECOS, NPPES) and ensure provider records are current.</li><li>Support onboarding of new providers/clients by aligning enrollment with system setup.</li><li>Generate and maintain reports on enrollment status, timelines, and issues.</li><li>Perform audits to ensure data accuracy and completeness</li></ul>Qualifications/Skills<ul><li>Bachelor&rsquo;s degree in Healthcare Administration, Business, or related field (or equivalent experience)</li><li>2+ years of experience in provider enrollment, credentialing, or medical billing/RCM</li><li>Strong understanding of payer enrollment processes and insurance requirements</li><li>Experience with EHR/EMR systems and medical billing platforms</li><li>Familiarity with CAQH, PECOS, NPPES, clearinghouses, and payer portals</li><li>Knowledge of EDI, ERA, EFT, and claims workflows</li><li>High attention to detail and accuracy in handling documentation and data</li><li>Strong organizational and time management skills with ability to manage multiple enrollments</li><li>Excellent communication skills for working with providers, payers, and internal teams</li><li>Problem-solving ability to address enrollment and reimbursement issues</li><li>Proficiency in Microsoft Excel and reporting tools</li></ul>Timings<ul><li>5:00 PM &ndash; 2:00 AM (Summers)</li><li>6:00 PM - 3:00 AM (Winters)</li></ul>Benefits<ul><li>Healthcare (OPD + IPD)</li><li>Entertainment Allowance</li><li>Cellular Allowance</li><li>Provident Fund</li></ul>Job Type: Full-timeApplication Question(s):<ul><li>Are you a resident of Bahria Town Phase 7/8, or DHA 1/2? If not, kindly state your area of residency.</li></ul>Work Location: In person

Enrollment Specialist

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