[Hiring] Credentialing and Payer Enrollment Specialist @RCM Staff LLC

Role Description

This is a remote position. RCM Staff BPO is hiring a part-time Credentialing and Payer Enrollment Specialist to support a medical billing company based in Texas that serves orthopedic and behavioral health practices. The specialist prepares and submits provider enrollment applications, maintains CAQH, PECOS, and NPPES records, and follows up with payers until applications are approved and effective dates are issued. This role requires strong attention to detail, consistent follow-up, and experience working with U.S. health insurance plans, including the ability to call payer provider relations directly and keep accurate records of every application.

• Prepare and submit initial payer enrollment applications for individual providers and group practices, for both 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 all 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 so that no provider lapses with a payer
• Collect and maintain provider credentialing documents such as 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 applications that are stalled or denied
• Protect patient information and follow HIPAA requirements

Qualifications

• 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

Preferred Qualifications

• Experience supporting a medical billing company or credentialing multiple practices at once
• Experience with orthopedic or behavioral health provider enrollment
• Familiarity with Texas commercial plans and Texas Medicaid
• Experience with state Medicaid enrollment portals in more than one state
• Experience using AdvancedMD, Practice Fusion, or TherapyNotes

Schedule

• Part-time position, approximately 20 hours per week
• Must be available during U.S. Central Time business hours
• Potential to move to full-time as credentialing volume grows
• Final schedule will be determined based on practice needs

Work Arrangement

• Remote
• Philippines-based applicants preferred