What are the responsibilities and job description for the Credentialing and Provider Enrollment Coordinator position at ExcelHealth Group?
Description
Credentialing & Provider Enrollment Specialist
About ExcelHealth Group
ExcelHealth Group is a growing leader in ancillary healthcare services, bringing Audiology, Dentistry, Optometry, and Podiatry care to long-term care communities nationwide. Our work helps expand access to high-quality care for seniors, and our credentialing and enrollment team plays a critical role in making that possible by ensuring providers are ready to serve quickly, compliantly, and efficiently.
We’re looking for a highly capable Credentialing & Provider Enrollment Specialist who brings strong judgment, exceptional attention to detail, and a sense of ownership to every stage of the credentialing and enrollment process. This role is ideal for someone who is energized by fast-moving work, can manage complexity with confidence, and knows how to balance accuracy, urgency, and service while coordinating across providers, payers, facilities, and third-party partners.
Position Summary
In this role, you will lead critical provider credentialing, recredentialing, payer enrollment, and provider data management activities that directly support speed to service, operational readiness, and patient access to care. You will work cross-functionally with independent provider groups, insurance carriers, long-term care facilities, and credentialing and billing partners to ensure providers are enrolled accurately, on time, and in full compliance with regulatory and contractual requirements.
The strongest candidates will bring hands-on expertise in CAQH, PECOS, Medicare, Medicaid, CMS regulations, and commercial insurance enrollment, along with the ability to stay organized under pressure, communicate clearly with multiple stakeholders, and proactively move work forward with minimal oversight.
Essential Responsibilities
Provider Credentialing & Enrollment
Required:
Credentialing & Provider Enrollment Specialist
About ExcelHealth Group
ExcelHealth Group is a growing leader in ancillary healthcare services, bringing Audiology, Dentistry, Optometry, and Podiatry care to long-term care communities nationwide. Our work helps expand access to high-quality care for seniors, and our credentialing and enrollment team plays a critical role in making that possible by ensuring providers are ready to serve quickly, compliantly, and efficiently.
We’re looking for a highly capable Credentialing & Provider Enrollment Specialist who brings strong judgment, exceptional attention to detail, and a sense of ownership to every stage of the credentialing and enrollment process. This role is ideal for someone who is energized by fast-moving work, can manage complexity with confidence, and knows how to balance accuracy, urgency, and service while coordinating across providers, payers, facilities, and third-party partners.
Position Summary
In this role, you will lead critical provider credentialing, recredentialing, payer enrollment, and provider data management activities that directly support speed to service, operational readiness, and patient access to care. You will work cross-functionally with independent provider groups, insurance carriers, long-term care facilities, and credentialing and billing partners to ensure providers are enrolled accurately, on time, and in full compliance with regulatory and contractual requirements.
The strongest candidates will bring hands-on expertise in CAQH, PECOS, Medicare, Medicaid, CMS regulations, and commercial insurance enrollment, along with the ability to stay organized under pressure, communicate clearly with multiple stakeholders, and proactively move work forward with minimal oversight.
Essential Responsibilities
Provider Credentialing & Enrollment
- Own high-volume credentialing and recredentialing workflows for providers across multiple states and specialties.
- Prepare, submit, and maintain provider enrollment applications for Medicare, Medicaid, and commercial payers.
- Maintain accurate, up-to-date provider information in CAQH, PECOS, and related systems.
- Track enrollment status, identify delays, and follow through with payers, providers, and external partners to keep timelines moving.
- Coordinate onboarding documentation and confirm all required credentials are collected, verified, and maintained.
- Monitor licensure, certifications, malpractice coverage, and other required provider documentation for completeness and renewal.
- Act as a trusted liaison between ExcelHealth Group, provider organizations, insurance carriers, and third-party credentialing and billing partners.
- Partner with external vendors to ensure credentialing and enrollment activities are completed accurately and on schedule.
- Resolve enrollment barriers, denials, and documentation issues with professionalism, persistence, and urgency.
- Support long-term care facilities with provider onboarding, credentialing requirements, and documentation needs.
- Complete facility credentialing packets and respond to provider documentation requests accurately and efficiently.
- Maintain organized records and ensure facility requirements are met on time and without gaps.
- Respond to facility inquiries with professionalism, responsiveness, and strong customer service.
- Ensure full compliance with CMS regulations, Medicare and Medicaid enrollment requirements, and payer-specific guidelines.
- Maintain accurate provider databases, tracking tools, and supporting documentation.
- Monitor expiration dates, renewal schedules, and compliance deadlines to reduce risk and avoid disruption.
- Audit provider files regularly to ensure data accuracy, completeness, and audit readiness.
- Communicate clearly and professionally with internal teams, providers, facilities, payers, and external business partners.
- Provide timely, accurate updates on credentialing and enrollment progress, risks, and next steps.
- Build strong working relationships through responsiveness, accountability, and service-oriented support.
Required:
- 3 years of provider credentialing and enrollment experience.
- Strong working knowledge of CAQH, PECOS, Medicare and Medicaid enrollment, commercial payer credentialing, and CMS rules and regulations.
- Demonstrated ability to manage multiple credentialing projects and deadlines at once.
- Exceptional attention to detail, organization, and follow-through.
- Proficiency in Microsoft Office, including Excel.
- Strong written and verbal communication skills.
- Ability to work independently, prioritize effectively, and meet deadlines in a fast-paced environment.
- Experience credentialing providers across multiple states.
- Experience supporting long-term care, skilled nursing, or senior living environments.
- Knowledge of provider billing and revenue cycle processes.
- Experience working with third-party credentialing or billing organizations.
- CPCS, CPMSM, or similar credentialing certification.
- Strong attention to detail
- Excellent organization and follow-through
- Critical thinking and sound judgment
- Problem-solving and issue resolution
- Time and priority management
- Professional, proactive communication
- Service-minded collaboration
- Regulatory and compliance awareness