Provider Credentialing & Enrollment Specialist
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Summary
This is a part-time, temporary position with the potential to transition into a full-time role This is a remote position We are seeking a detail-oriented Credentialing & Enrollment Specialist to support provider enrollment, revalidation, and ongoing maintenance across multiple payors and states. This role focuses on resolving enrollment issues, reducing denials, and ensuring timely provider participation and reimbursement.Description
Credentialing & Enrollment Support
- Review and resolve enrollment with focus on state-specific requirements.
- Identify and trend denial patterns to prevent recurrence (e.g., taxonomy mismatches, missing DEA, non-participating providers, admitting privileges).
- Review Medicaid applications, revalidations, and facility enrollments at both group and individual levels.
- Support NY ETIN and ETINS processing as required.
Roster & Reporting Management
- Prepare and submit monthly rosters and uploads, including new provider additions and terminations.
- Manage delegated rosters such as NY-NJ Fidelis and submissions through 3rd party vendor Medallion platform
Compliance & Payor Requirements
- Track and resolve payors pending over 90 days and identify roadblocks.
Communication & Administrative Support
- Manage incoming emails and correspondence and confirm appropriate mail types and follow-up actions.
- Support telehealth enrollment workflows and system integrations.
- Assist with administrative tasks, documentation, and audit readiness.
Performance & Process Improvement
- Ensure requests submitted through 3rd party vendor Medallion are timely and accurate.
- Collaborate with leadership to identify root causes of delays and prevent recurrence.
Qualifications
- Experience minimum two years in provider credentialing and enrollment, including Medicaid/revalidations/ETIN certifications for NY/NJ states
- Knowledge of CAQH, Application utilizing our 3rd party vendor platform-Medallion
- Strong attention to detail and analytical skills.
- Ability to manage multiple priorities in a fast-paced environment
EEO Statement
PM Pediatric Care is an equal employment opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sexual orientation, gender identity or expression, national origin, disability status, protected veteran status or any other characteristic protected by law.
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