About the payer enrollment role
New practices, new locations and new providers all need the same thing before they can bill: enrollment with each payer, linked to the right group, tax ID and location, with claims and payments flowing electronically. As a payer enrollment specialist you handle the group side of that work and the plumbing that follows it.
You will work closely with our credentialing specialists. They focus on the individual provider file; you focus on group enrollment, linkage, and the EDI, ERA and EFT setup that is easy to forget and expensive to miss.
What you will do
- Submit and track Medicare group and individual enrollment and reassignment in PECOS
- Complete state Medicaid and Medicaid managed care plan enrollment
- Add providers and locations to existing commercial contracts and confirm linkage
- Set up EDI claim submission, ERA (835) and EFT enrollment with each payer and the clearinghouse
- Update NPPES records, practice locations and pay-to addresses when anything changes
- Handle revalidation notices and ownership or tax ID changes on time
- Keep an enrollment grid for each client showing every payer, status and effective date
What you need
- One or more years of payer enrollment, credentialing or billing setup experience
- Experience with PECOS and at least one state Medicaid enrollment portal
- Understanding of type 1 and type 2 NPIs, tax IDs, taxonomy codes and group linkage
- Careful attention to detail on forms where one wrong digit stalls an application
- Good written communication for payer correspondence and client updates
Helpful, not required
Experience with CAQH ProView, Availity and payer-specific portals, and with clearinghouse enrollment in tools such as Office Ally, Availity or Change Healthcare.
Working remotely at CredSpun
This is a fully remote, work-from-home role open to applicants living in the United States. You work during U.S. business hours alongside a named account team, inside each client practice's own EHR and practice management system, with every login tied to you personally. You need a quiet, private workspace, a reliable broadband connection and a computer that can run a current browser and a second monitor. HIPAA training is part of onboarding, and you sign our confidentiality terms before you are given access to any patient data.