Credentialing and Payer Enrollment Specialist – Part-time

RCM Staff LLC

. Prepare and submit initial payer enrollment applications for individual providers and group practices for commercial and government plans .

Posted 9/22/2026part-timeRemote • PhilippinesJuniorMid-LevelWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in U.S. provider credentialing and payer enrollment, with proficiency in CAQH ProView, PECOS, and NPPES. Capable of managing multiple applications and maintaining compliance with HIPAA requirements while ensuring attention to detail.

Highest-signal resume keywords

U.S. Provider CredentialingPayer EnrollmentCAQH ProViewPECOSNPPES

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Payer Enrollment ApplicationsCredentialing Document ManagementRecredentialing and RevalidationDemographic Changes TrackingInsurance Website Navigation

Soft Skills

Attention to DetailFollow-Up SkillsIndependent Work

Tools & Technologies

AdvancedMDPractice FusionTherapyNotes

Industry Keywords

Commercial InsuranceGovernment Health PlansMedicareMedicaidTexas Medicaid

About the role

Key responsibilities & impact

Prepare and submit initial payer enrollment applications for individual providers and group practices for commercial and government plans
Complete, update, and attest CAQH ProView profiles and keep supporting documents current
Maintain provider records in PECOS and NPPES, including revalidations, reassignments, and demographic changes
Track pending applications and follow up with payer provider relations by phone, portal, and email until effective dates are confirmed
Manage the recredentialing and revalidation calendar to prevent provider lapses with payers
Collect and maintain credentialing documents, including state licenses, DEA registrations, malpractice certificates of insurance, board certifications, W-9s, and CVs, and track expiration dates
Submit roster updates, group additions and terminations, and demographic changes to payers
Document every application, payer contact, reference number, and effective date in the client’s credentialing tracker
Provide a weekly status report to the client contact and escalate stalled or denied applications
Protect patient information and follow HIPAA requirements

Requirements

What you’ll need

At least 2 years of experience in U.S. provider credentialing and payer enrollment
Hands-on experience with CAQH ProView, PECOS, and NPPES
Familiarity with commercial insurance and government health plans, including Medicare and Medicaid
Experience using payer portals and insurance websites
Comfortable making outbound telephone calls to payer provider relations and network representatives
Strong written and spoken English
Excellent attention to detail and follow-up skills
Ability to work independently and manage multiple providers and applications at the same time
Reliable internet connection and a suitable remote workspace
Experience with orthopedic or behavioral health provider enrollment is preferred
Familiarity with Texas commercial plans and Texas Medicaid is preferred
Experience with state Medicaid enrollment portals in more than one state is preferred
Experience using AdvancedMD, Practice Fusion, or TherapyNotes is preferred
Must be available during U.S. Central Time business hours

Benefits

Comp & perks

Potential to move to full-time as credentialing volume grows
Remote work arrangement
Approximately 20 hours per week
Philippines-based applicants preferred