Credentialing and Provider Enrollment Specialist
这是一个远程职位。工作总结 RCM 员工 BPO 正在聘请一名兼职认证和提供商注册专家来支持位于格鲁吉亚的骨科脊椎手术实践。该专家将管理医疗保险，医疗补助和商业支付者的供应商和团体注册，维护 CAQH 个人资料，并通过批准跟踪每个申请。此角色需要 PECOS 通过 Medicare 注册经验，对细节密切关注，一致的追踪以及与美国健康保险计划合作的经验。关键责任 · 通过 PECOS 编制，提交和跟踪医疗保险注册申请，包括个人，团体以及转让福利申请 · 对医疗保养管理承包商的开发请求作出回应并纠正应用程序问题以保持注册流动 · 为新或现有实践地点完成医疗保育及商业支付人认证和合同申请 · 使用提供者授权访问创建，更新和重新验证 CAQH ProView 配置文件 ·维护 NPI,许可证，DEA,董事会认证，不行业务和医院特许记录，期限日期。· 通过电话，电子邮件和门户网站跟踪付款人直到每个申请被批准并确认有效日期。• 在实践的认证追踪器中记录应用程序状态，参考号码和有效日期；•通知经验者获得批准，拒绝，丢失文件以及即将推迟或重新认证期限。•处理新地点，地址变更和附加服务等人口统计更新。· 实践经验提交和管理医疗保险申请在 PECOS,包括 CMS-855注册和转让 ·熟悉商业保险和政府健康计划 · CAQH ProView,NPPES 和支付人注册门户的经验 ·强有力的书面和口头英语 ·精致关注细节和后续技能 ·独立工作的能力以及多项应用程序和截止日期 ·可靠互联网连接和适当的远程工作空间优先资格 ·经历认证外科医生或骨科，脊椎或疼痛管理等专业实践 ·经验录取新成立的团体实践，在
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This is a remote position.
Job Summary
RCM Staff BPO is hiring a part-time Credentialing and Provider Enrollment Specialist to support an orthopedic spine surgery practice based in Georgia.The specialist will manage provider and group enrollment with Medicare, Medicaid, and commercial payers, maintain CAQH profiles, and track every application through approval. This role requires hands-on Medicare enrollment experience through PECOS, strong attention to detail, consistent follow-up, and experience working with U.S. health insurance plans.Key Responsibilities
- Prepare, submit, and track Medicare enrollment applications through PECOS, including individual, group, and reassignment of benefits applications
- Respond to Medicare Administrative Contractor development requests and correct application issues to keep enrollments moving
- Complete Medicaid and commercial payer credentialing and contracting applications for new and existing practice locations
- Create, update, and re-attest CAQH ProView profiles using provider-authorized access
- Maintain NPI, license, DEA, board certification, malpractice, and hospital privilege records with expiration dates
- Follow up with payers by phone, email, and portal until each application is approved and effective dates are confirmed
- Track application status, reference numbers, and effective dates in the practice's credentialing tracker
- Notify the practice of approvals, denials, missing documents, and upcoming revalidation or re-credentialing deadlines
- Process demographic updates such as new locations, address changes, and added services with each payer
- Protect patient and provider information and follow HIPAA requirements
Qualifications
· At least 2 years of experience with U.S. healthcare credentialing and provider enrollment
- Hands-on experience submitting and managing Medicare applications in PECOS, including CMS-855 enrollment and reassignment
- Familiarity with commercial insurance and government health plans
- Experience with CAQH ProView, NPPES, and payer enrollment portals
- Strong written and spoken English
- Excellent attention to detail and follow-up skills
- Ability to work independently and manage multiple applications and deadlines
- Reliable internet connection and a suitable remote workspace
Preferred Qualifications
- Experience credentialing surgeons or specialty practices such as orthopedics, spine, or pain management
- Experience enrolling a newly formed group practice, including multiple locations
- Familiarity with Georgia Medicaid and Georgia commercial insurance plans
- Experience with hospital and ambulatory surgery center privileging
Schedule
· Part-time position
- Must be available during Eastern Time business hours
- Final schedule will be determined based on practice needs
Work Arrangement
- Remote
- Philippines-based applicants preferred
Originally posted on Himalayas