Credentialing and Provider Enrollment Specialist
This is a remote position.
Job SummaryRCM Staff BPO is hiring a part-time Credentialing and Provider Enrollment Specialist to support an orthopedic spine surgery practice based in Georgia.The specialist will manage provider and group enrollment with Medicare, Medicaid, and commercial payers, maintain CAQH profiles, and track every application through approval. This role requires hands-on Medicare enrollment experience through PECOS, strong attention to detail, consistent follow-up, and experience working with U.S. health insurance plans.Key Responsibilities- Prepare, submit, and track Medicare enrollment applications through PECOS, including individual, group, and reassignment of benefits applications
- Respond to Medicare Administrative Contractor development requests and correct application issues to keep enrollments moving
- Complete Medicaid and commercial payer credentialing and contracting applications for new and existing practice locations
- Create, update, and re-attest CAQH ProView profiles using provider-authorized access
- Maintain NPI, license, DEA, board certification, malpractice, and hospital privilege records with expiration dates
- Follow up with payers by phone, email, and portal until each application is approved and effective dates are confirmed
- Track application status, reference numbers, and effective dates in the practice's credentialing tracker
- Notify the practice of approvals, denials, missing documents, and upcoming revalidation or re-credentialing deadlines
- Process demographic updates such as new locations, address changes, and added services with each payer
- Protect patient and provider information and follow HIPAA requirements
- At least 2 years of experience with U.S. healthcare credentialing and provider enrollment
- Hands-on experience submitting and managing Medicare applications in PECOS, including CMS-855 enrollment and reassignment
- Familiarity with commercial insurance and government health plans
- Experience with CAQH ProView, NPPES, and payer enrollment portals
- Strong written and spoken English
- Excellent attention to detail and follow-up skills
- Ability to work independently and manage multiple applications and deadlines
- Reliable internet connection and a suitable remote workspace
- Experience credentialing surgeons or specialty practices such as orthopedics, spine, or pain management
- Experience enrolling a newly formed group practice, including multiple locations
- Familiarity with Georgia Medicaid and Georgia commercial insurance plans
- Experience with hospital and ambulatory surgery center privileging
- Part-time position
- Must be available during Eastern Time business hours
- Final schedule will be determined based on practice needs
- Remote
- Philippines-based applicants preferred
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