Credentialing Payer Enrollment Specialist

Key Responsibilities:

1. Federal & State Enrollment (Medicare/Medicaid

• Independently manage the complete Medicare enrollment process via PECOS, including the preparation and submission of CMS-855I, 855B, 855R, and DME applications.
• Manage the full NPI (Type 1 and Type 2) lifecycle through NPPES, including new registrations and updates.
• Directly submit and track state-specific Medicaid enrollment applications through state portals without departmental handoffs.
• Maintain and navigate the Identity & Access (I&A) Management System to manage authorized official roles.

2. CAQH & Commercial Payer Management

• Take 100% ownership of CAQH ProView profiles: initial setup, quarterly re-attestations, and ensuring all documentation (COI, licenses, board certs) is current.
• Execute full-cycle commercial credentialing through Availity and individual payer portals (Anthem, BCBS, Aetna, Cigna, ...