Job Description

Job Description

Job Description

HYBRID

**This position follows a hybrid schedule, with some days worked remotely and others in the office.**

The Payer Enrollment and Credentialing Specialist is responsible for overseeing all aspects of provider credentialing, payer enrollment, and re-enrollment with commercial and government payers (e.g., Medicare, Medicaid). This role ensures the timely submission and maintenance of provider data to support compliance, billing, and reimbursement processes. The specialist acts as a liaison between providers, payers, and internal departments to ensure efficient provider participation in insurance networks.

**This is a fast-paced and deadline-driven role requiring strong attention to detail and organizational skills.**

Key Responsibilities:

Credentialing:

• Manage the credentialing and recredentialing processes for healthcare providers in accordance with payer, regulatory, and organizational standards.
• Verify provider credentials, including education, licensure, certifications, work history, malpractice coverage, and references.
• Maintain accurate provider files in credentialing databases (e.g., CAQH, NPPES, PECOS, Credentialing Software, etc).
• Track and ensure timely renewal of licenses, certifications, and other credentials.

Payer Enrollment:

• Prepare, submit, and monitor provider enrollment and re-enrollment applications for Medicare, Medicaid, HMO, and Commercial payers.
• Monitor and follow-up on application statuses with payers to ensure timely processing and approvals.
• Maintain up-to-date records of enrollment data and payer contacts.
• Respond to payers and/or client’s requests for additional information, corrections, or documentation.
• Track credentialing and enrollment expiration dates and ensure timely renewals.
• Resolve payer enrollment issues that impact claims processing and reimbursement.
• Maintain a comprehensive database of provider enrollment information and payer contacts.

Compliance & Documentation:

• Ensure all credentialing and enrollment processes comply with NCQA, CMS, state, and payer guidelines.
• Maintain organized documentation and generate regular credentialing and enrollment status reports.

Communication & Support:

• Serve as liaison between providers, payers, billing teams, and healthcare administrators.
• Educate providers/clients on credentialing and enrollment processes and timelines.
• Respond to credentialing-related inquiries in a timely and professional manner.

Qualifications:

Education & Experience:

• High school diploma or GED required, associate or bachelor’s degree in healthcare administration or related field preferred.
• Minimum 5 years of experience in payer enrollment or provider credentialing in a healthcare setting.
• Familiarity with Medicare, Medicaid, and commercial insurance plans.
• Experience using CAQH, PECOS, and payer-specific portals.

Skills:

• Strong knowledge of the payer enrollment process and healthcare credentialing requirements.
• Excellent organizational skills with attention to detail.
• Effective verbal and written communication.
• Ability to prioritize and manage multiple tasks and deadlines.
• Proficiency in Microsoft Office (Excel, Outlook, Word).
• Experience with credentialing/enrollment software systems preferred (Modio)

**Signing Bonus after successful completion of a probationary period**

Salary is commensurate with experience.

**This position follows a hybrid schedule, with some days worked remotely and others in the office.**

Sierra Health Group is a health services company that provides the full cycle of revenue services for all types of healthcare provider organizations

Company Description

Sierra Health Group is a health services company that provides the full cycle of revenue services for all types of healthcare provider organizations

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