Credentialing & Health Plan Enrollment Specialist

Job Description

This is a remote position.

Schedule : Monday–Thursday, 8 : 00 AM – 5 : 30 PM EST; Friday, 8 : 30 AM – 12 : 30 PM EST

Contract Duration : 3 months

Total Weekly Hours : 42 Hours

Our client is seeking a Credentialing & Health Plan Enrollment Specialist to support provider demographic changes, credentialing, and health plan enrollment for physicians and ancillary providers within a clinical group practice. This role requires close collaboration with providers, practice administrators, billing vendors, health plans (commercial and governmental), and credentialing vendors to ensure compliance, accuracy, and efficiency.

The Specialist will be responsible for maintaining credentialing documentation, ensuring compliance with healthcare regulations, and supporting enrollment processes that enable timely and accurate reimbursement. Success in this role requires strong organizational skills, attention to detail, and the ability to effectively manage multiple stakeholders.

Responsibilities

Manage the full credentialing lifecycle for healthcare providers, including initial credentialing, re-credentialing, and health plan enrollment

Ensure credentialing documentation is accurate, complete, and compliant with regulatory standards and payer requirements

Maintain up-to-date knowledge of healthcare regulations, accreditation standards, and payer policies

Collaborate with internal teams, providers, and external agencies to resolve credentialing issues and ensure timely processing

Oversee health plan enrollment processes, including eligibility verification, application submission, and status tracking

Support billing and coding teams by aligning credentialing and enrollment data with reimbursement processes

Maintain accurate provider files, licenses, DEA certificates, malpractice coverage, and other required documentation

Assist providers with CAQH applications and other enrollment-related requirements

Participate in quality improvement initiatives to streamline credentialing and enrollment operations

Ensure compliance with HIPAA regulations and maintain confidentiality of sensitive data

Requirements

Bachelor’s degree in Healthcare, Business, Finance, or related field OR a minimum of 3 years of equivalent healthcare experience

3–5 years of proven experience in credentialing and health plan enrollment (Medicare, Medicaid, commercial insurers, and TPAs)

Strong knowledge of healthcare regulations, accreditation standards, and payer requirements

High attention to detail with strong record-keeping and compliance management skills

Proficiency in Microsoft Office Suite (Excel, Word, PowerPoint, Visio) and online credentialing databases

Excellent written and verbal communication skills; professional interaction with diverse stakeholders

Strong problem-solving, decision-making, and organizational abilities

Ability to work independently with minimal supervision while contributing to a collaborative team environment

Competencies

Results-driven and detail-oriented

Strong interpersonal and communication skills

Ability to handle sensitive information with confidentiality

Customer service mindset with a commitment to quality and compliance

Adaptability in a dynamic, fast-paced healthcare environment

Work Environment & Schedule

Standard business hours with occasional extended hours or weekend requirements

Regular use of standard office equipment and virtual collaboration tools

Independent Contractor Perks

Permanent work-from-home arrangement

Immediate hiring

Commissions and incentives

ZR_28010_JOB

Requirements

Bachelor’s degree in Healthcare, Business, Finance, or related field OR a minimum of 3 years of equivalent healthcare experience 3–5 years of proven experience in credentialing and health plan enrollment (Medicare, Medicaid, commercial insurers, and TPAs) Strong knowledge of healthcare regulations, accreditation standards, and payer requirements High attention to detail with strong record-keeping and compliance management skills Proficiency in Microsoft Office Suite (Excel, Word, PowerPoint, Visio) and online credentialing databases Excellent written and verbal communication skills; professional interaction with diverse stakeholders Strong problem-solving, decision-making, and organizational abilities Ability to work independently with minimal supervision while contributing to a collaborative team environment