Provider Enrollment Specialist

TL;DR

Provider Enrollment Specialist: Coordinates provider payer enrollment/credentialing and recredentialing for professional services reimbursement with an accent on accurate credentialing data, timely payer-specific submissions, and resolving enrollment issues. Focus on process improvements, primary source verification research, and maintaining enrollment tracking systems to support compliant provider onboarding.

Location: Working at Home - Pennsylvania

Company

hirify.global coordinates provider enrollment and credentialing for Allegheny Clinic professional providers across payers.

What you will do

• Complete provider payer enrollment/credentialing and recredentialing with identified payers in a timely manner.
• Resolve enrollment issues by collaborating with physicians, office staff, management, contracting, insurers, and other stakeholders.
• Obtain and update provider information from multiple sources and perform primary source verification research.
• Proactively maintain credentialing data before expiration and manage enrollment matrices and departmental software.
• Communicate changes in credentialing requirements and payer enrollment information (including provider numbers) to practice operations.
• Track providers using databases/spreadsheets and continuously improve processes for accuracy and efficiency.

Requirements

• 2 years of experience in a physician medical practice with basic understanding of payer billing requirements/claims processing or experience with payer credentialing/enrollment.
• Experience with payer enrollment/credentialing processes, including CAQH, NCQA, and PECOS.
• Advanced computer skills (Word, Excel, Adobe, and web-based applications) and expert-level Excel proficiency.
• Strong customer service, follow-up, and communication skills.
• Ability to excel in a fast-paced environment while managing high-volume competing priorities.
• Ability to protect highly sensitive and confidential information and comply with HIPAA and company privacy/security policies.

Culture & Benefits

• Compliance-focused role with required adherence to HIPAA, privacy/security guidelines, and the company Code of Business Conduct.
• Work involves handling highly sensitive and confidential provider information.
• Emphasis on accuracy, timely follow-up, and continuous process improvement.