Provider Enrollment Specialist (Credentialing)
About VitalCare VitalCare Health Services is a telehealth provider supporting skilled nursing facilities (SNFs) and long-term care organizations. Our platform connects facility nurses/patients with experienced providers to ensure timely treatment decisions and appropriate pain management for patients in post-acute and long-term care settings. Job Summary The Provider Enrollment Specialist is responsible for managing the end-to-end enrollment and credentialing process for healthcare providers with Medicare, Medicaid, and commercial insurance payers. This role ensures accurate and timely submission of provider applications, maintenance of provider records, and compliance with federal, state, and payer-specific requirements. The specialist serves as a key liaison between healthcare providers, insurance carriers, and regulatory agencies to ensure providers are properly enrolled and credentialed to deliver services and receive reimbursement.
Key Responsibilities
Provider Enrollment & Credentialing Prepare, submit, and manage provider enrollment applications for Medicare, Medicaid, and commercial insurance payers. Complete enrollments through platforms such as CAQH, PECOS, Availity, and payer portals. Monitor application progress and follow up with payers to ensure timely approval. Maintain provider records and supporting documentation including licenses, DEA registrations, malpractice insurance, board certifications, and education history. Ensure all provider files meet payer and regulatory credentialing requirements. Application Processing Review provider applications for completeness and accuracy prior to submission. Track enrollment status and maintain detailed logs of all submissions and communications. Respond to payer requests for additional information or corrections. Manage revalidations, updates, and recredentialing cycles as required. Compliance & Documentation Maintain compliance with CMS regulations, state Medicaid requirements, and commercial payer policies. Ensure provider files meet audit standards and credentialing committee requirements. Maintain organized electronic credentialing files. Provider & Payer Communication Serve as a point of contact for providers regarding enrollment status and requirements. Communicate with insurance carriers, CMS contractors, and state agencies to resolve enrollment issues. Assist providers with CAQH attestations and profile maintenance. Data Management Maintain accurate provider information within internal systems or credentialing databases. Track key dates such as license renewals, DEA expiration, malpractice coverage, and credentialing deadlines.
Qualifications
Education Equivalent work experience in provider enrollment or credentialing. Experience 4+ years of provider enrollment or credentialing experience. Experience enrolling providers with Medicare (PECOS), Medicaid, and commercial payers. Familiarity with CAQH ProView, NPI Registry, and payer portals. Skills Strong understanding of provider enrollment and credentialing processes. Knowledge of CMS regulations and payer credentialing standards. Excellent attention to detail and organizational skills. Ability to manage multiple enrollments and deadlines simultaneously. Strong written and verbal communication skills. Technical Skills Experience with credentialing software or CRM systems. Proficiency in CAQH, PECOs, Microsoft Excel, Word, Adobe Acrobat Pro, and online payer portals.
Preferred Qualifications
Experience with multi-state provider enrollments. Experience credentialing physicians, nurse practitioners, and physician assistants.
Work Environment
Remote work environment. Fast-paced administrative setting supporting healthcare providers nationwide. Key Performance Indicators (KPIs) Average provider enrollment turnaround time Application approval rate Accuracy of submissions Number of enrollments processed per month Apply To This Job