Description:
MetaCare is looking for an experienced Credentialing Specialist to join our growing team. If you have hands-on experience with provider enrollment, payer credentialing, and EFT/EDI enrollment, we'd love to hear from you.
Key Responsibilities
- Complete provider credentialing and recredentialing with commercial insurance payers, Medicare, and Medicaid.
- Submit and track enrollment applications through PECOS, CAQH, NPPES, and payer portals.
- Set up and manage Electronic Funds Transfer (EFT) and Electronic Data Interchange (EDI/ERA/EDI Claims) enrollments with insurance payers.
- Complete ERA (Electronic Remittance Advice) enrollments and payment registrations through payer portals, clearinghouses, and payment vendors (e.g., ECHO Health, PaySpan, Zelis, Optum, etc.).
- Follow up with insurance companies on pending credentialing, enrollment, EFT, and EDI requests until completion.
- Maintain provider records and ensure all licenses, certifications, and supporting documents remain current.
- Coordinate with providers to obtain required documentation.
- Maintain accurate credentialing databases and enrollment reports.
- Assist with provider onboarding, group enrollments, and payer contract updates.
- Ensure compliance with payer and regulatory requirements.
Requirements
- Proven experience in medical provider credentialing.
- Strong knowledge of CAQH, PECOS, NPPES, Medicare, Medicaid, and commercial payer enrollment.
- Hands-on experience with EFT, ERA, and EDI enrollments for commercial and government payers.
- Experience with individual and group provider enrollments.
- Ability to manage multiple applications and meet deadlines.
- Strong attention to detail and excellent organizational skills.
- Excellent written and verbal communication skills.