Credentialing and Provider Enrollment Specialist

Your Opportunity
As a Credentialing and Provider Enrollment Specialist, your primary responsibility is to compile, maintain, and verify provider data and profiles. Operating in both delegated and non-delegated payors, you will efficiently complete provider enrollment and re-credentialing applications for various insurance plans, ensuring accuracy and adherence to deadlines. Communication is key as you interact professionally with providers and liaisons to gather required information.

Your role involves monitoring and updating expiring licenses and certifications, tracking enrollment details, and conducting audits for plan directories. In this fast-paced environment, you maintain confidentiality, resolve enrollment issues, and contribute to the seamless functioning of the credentialing process.

What you will do
Compile, maintain, and verify provider data and profiles

Accurately and efficiently complete provider enrollment and re-credentialing applications for all insurance plans

Works in both delegated and non-delegated payors, credentialing, and rostering providers for participation

Professionally communicate with all providers and provider liaisons while requesting and obtaining information

Monitor and update all expiring licensure, boards, and professional certifications

Track all provider enrollment and participation with effective dates, ID numbers and plan specification

Research and resolve all provider enrollment issue

Audit Commercial and Medicaid plan directories for current and accurate provider information

Ability to work in a fast-paced, high-volume environment with multiple completing deadlines

Maintains confidentiality of provider data

Perform other related duties as assigned by management

What will make you successful here
2 years of administrative background in a healthcare setting.

2 years of credentialing and re-credentialing experience.

Knowledge of CAQH, AMA, DEA, CMS, PECOS, OIG, ABMS, AOA, OPSED.

Strong organizational and data entry skills.

Effective communication (verbal and written).

Proficiency in Microsoft Office (Excel, Word, PowerPoint, and Outlook).

Experience with Symplr and Intellicred software programs.

Familiarity with commercial and government payors.

Strong working knowledge of NCQA regulations and requirements.

Ability to work independently and as a team player.

Ability to create and present PowerPoint and Excel presentations.

Manage tasks in a high-volume environment with competing deadlines.

Maintain confidentiality while handling sensitive provider data.

Resolve provider enrollment issues efficiently.

Stay updated on industry regulations and compliance standards.

Competitive base compensation

Annual bonus potential

Health benefits effective on start date

Health & Wellness Program; up to $300 per quarter for your overall well-being available on start date

401K plan effective on the first of the month after your start date; 100% of up to 4% of your annual salary

Unlimited (or generous) paid "Vytal Time", and 5 paid sick days after your first 90 days

Company paid STD/LTD

Technology setup

Ability to help build a market leader in value-based healthcare at a rapidly growing organization

 
*Please note at no time during our screening, interview, or selection process do we ask for additional personal information (beyond your resume) or account/financial information. We will also never ask for you to purchase anything; nor will we ever interview you via text message. Any communication received from a Vytalize Health recruiter during your screening, interviewing, or selection process will come from an email ending in @vytalizehealth.com
 
*We fully embrace the power of AI and encourage innovative, responsible use of emerging technologies in our work.

However, during the interview and assessment process, it’s essential that we evaluate your individual skills, problem-solving ability, and technical mastery without external assistance. Candidates must complete all interviews and assessments independently. Use of AI tools, platforms, or automated assistance during interviews or assessments is not permitted.

Unauthorized use will result in immediate disqualification from the hiring process and withdrawal of employment consideration. Our goal is to ensure a fair and accurate assessment of your true capabilities—the same creativity and critical thinking we value once you join our team.