Payer Enrollment & Credentialing Specialist

Responsibilities

We are representing a healthcare organization seeking a Payer Enrollment & Credentialing Specialist to manage provider credentialing, payer enrollment, re-credentialing, and ongoing provider compliance operations.

You will prepare and submit provider enrollment applications to commercial insurance payers, Medicare, Medicaid, and other health plans, managing each application from initial submission through approval and effective date. This includes following up directly with insurance companies regarding pending applications, missing documentation, corrections, and enrollment status, as well as responding promptly to payer requests for additional information.

Your responsibilities include tracking application submissions, reference numbers, effective dates, payer decisions, and outstanding requirements. You will assist with payer-related updates such as demographic changes, practice location updates, provider additions, terminations, and other enrollment maintenance. When enrollment delays or issues arise, you will proactively work with payers and internal teams toward resolution while maintaining accurate records of provider participation and payer enrollment status.

On the credentialing side, you will manage initial credentialing and re-credentialing requirements for healthcare providers. This involves collecting, reviewing, organizing, and maintaining provider credentialing documents, verifying provider information including NPI, licenses, certifications, education, work history, and malpractice coverage. You will audit provider files for missing, inaccurate, outdated, or expired documentation, monitor expiration and renewal dates, and proactively follow up on required documentation.

You will maintain accurate provider demographic and professional information across credentialing and payer systems, ensuring consistency across applications, payer portals, and internal records. Documentation of communications and follow-up activities with payers is essential, as is maintaining credentialing and payer enrollment trackers to provide clear visibility into pending, completed, and outstanding applications.

What We're Looking For

• Hands-on experience with payer enrollment and provider credentialing processes
• Demonstrated experience completing and submitting healthcare provider enrollment applications
• Familiarity with commercial payers, Medicare, and/or Medicaid enrollment processes
• Experience managing credentialing or enrollment applications from submission through approval
• Knowledge of provider credentialing documentation including NPI, professional licenses, certifications, and malpractice insurance
• Experience with initial credentialing and re-credentialing workflows
• Proven ability communicating and following up directly with insurance payers regarding application status and outstanding requirements
• Familiarity with credentialing platforms, payer portals, and provider databases highly preferred
• Experience maintaining credentialing/enrollment trackers and managing multiple deadlines simultaneously
• Previous healthcare administrative experience preferred
• Strong understanding of the difference between provider credentialing and payer enrollment and how the two processes work together
• Highly organized and detail-oriented with strong documentation and tracking skills
• Able to independently follow up on pending applications without requiring constant supervision
• Strong problem-solving skills when dealing with payer delays, missing documentation, or application discrepancies
• Excellent written and verbal English communication skills
• Comfortable communicating professionally with insurance representatives, providers, and internal teams
• Strong commitment to accuracy, confidentiality, and HIPAA compliance
• Must be able to provide NBI Clearance and/or Local Police Clearance before onboarding
• Must be available to attend video meetings with camera on when required
• Reliable computer and stable high-speed internet connection (minimum 25 Mbps)
• Noise-canceling headset and working webcam
• Quiet and professional work environment

Work Schedule: Full-time, 9:00 AM – 6:00 PM PDT, Monday to Friday, remote from the Philippines

How We Work With You

All candidates apply directly through Get A Job.ai. Our talent team will review your application and conduct an initial screening to understand your background and experience with payer enrollment and credentialing. Qualified candidates will then be submitted to our client for their consideration. Please do not attempt to contact the client directly, as all communication and coordination flows through our recruiting team at Get A Job.ai.

Pay

This is an independent contractor position. Our client offers $5–$6 per hour depending on experience.

Equal Opportunity: Get A Job.ai is committed to fair and equitable recruiting practices. We evaluate all candidates based on qualifications and experience.