Payor Enrollment Specialist

The Payor Enrollment Specialist is responsible for managing the full cycle of provider and group credentialing, enrollment, and maintenance with health insurance payors (commercial, Medicare, Medicaid). This role ensures compliance with contractual requirements, accurate provider data, timely submissions, and renewals to enable claims reimbursement and maintain in-network status. This is a remote, work from home position, however candidate must live in FL and have experience with Florida payors.

🧠 Key Responsibilities

Credentialing & Enrollment

• Manage and maintain enrollment for providers and the practice with all applicable payors and networks.
• Prepare and complete credentialing applications (initial and re-credentialing) for Medicare, Medicaid, TRICARE, and commercial payors.
• Maintain provider profiles in CAQH, PECOS, and other payor portals.

Payor Relations & Compliance

• Serve as primary point of contact with payor credentialing and contracting teams to resolve discrepancies and accelerate approvals.
• Track application statuses, follow up on outstanding items, and communicate updates to providers and internal stakeholders.
• Monitor and track all credentialing and enrollment deadlines, renewals, re-validations, and re-appointments.

Documentation & Reporting

• Maintain accurate credentialing databases and records, ensuring compliance with internal and external audit standards.
• Generate credentialing reports for leadership, compliance, and operational teams.
• Collaborate with revenue cycle, HR, and operations to support provider onboarding.

Process Improvement

• Identify and implement workflow improvements to streamline credentialing and enrollment processes.
• Ensure adherence to regulatory and payor credentialing standards and timelines.

🎓 Required Qualifications

• Experience: 3 years of progressive experience in provider credentialing and payor enrollment, preferably in multi-specialty ambulatory settings or large practices.
• Education:
  • High school diploma or GED required;
  • Associate’s degree or higher in healthcare administration, business, or related field preferred.
• Skills:
  • Proficiency with CAQH ProView, Medicare PECOS, and major commercial payor portals.
  • Strong organizational and communication skills.
  • Detail-oriented, able to manage multiple deadlines and complex documentation.
• Preferred:
  • Certified Provider Credentialing Specialist (CPCS) through NAMSS.