Credentialing and Enrollment Specialist

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Profile Overview

We are seeking a detail-oriented, proactive, and experienced Credentialing and Enrollment Specialist to join our growing team. In this role, youll manage the entire provider credentialing and payer enrollment lifecycle — ensuring compliance with payer and government regulations, timely reimbursements, and accurate provider data. This position requires strong organizational skills, hands-on technical expertise, and the ability to manage multiple payer relationships efficiently.

Role Purpose: What You’ll Be Doing

• Complete, monitor, and follow up on provider credentialing and recredentialing applications across commercial, Medicaid, Medicare, and managed care payers.
• Manage EFT and ERA enrollments with payers and clearinghouses to ensure accurate and timely payment processing.
• Maintain and update CAQH, PECOS, and NPPES profiles for all providers.
• Create and manage provider records in Modio Health credentialing platform, ensuring accuracy and completeness.
• Work with TriZetto and other clearinghouse portals to track enrollment submissions and payer confirmations.
• Update provider demographic data, terminations, and additions in all payer systems as required.
• Maintain a detailed tracking system for application progress, effective dates, and next follow-up actions.
• Ensure timely renewals of licenses, certifications, malpractice coverage, and other credentialing requirements.
• Coordinate directly with payers, providers, and internal teams to resolve application discrepancies and rejections.
• Provide periodic updates to management on credentialing turnaround time and enrollment pipeline status.
• Support process improvement initiatives to reduce credentialing cycle times and increase accuracy.

Must-Have Skills

• 5+ years of proven experience in Provider Credentialing and Enrollment (U.S. healthcare).
• Expertise in EFT and ERA enrollments with major payers and clearinghouses.
• Hands-on experience with CMS, PECOS, CAQH, and NPPES portals.
• Practical experience using Modio Health for provider management (required).
• Working knowledge of TriZetto portal for payer enrollments and status verification.
• Excellent written and verbal communication skills.
• Strong organizational skills with the ability to manage multiple tasks simultaneously.
• Proficiency in Microsoft Office (Excel, Word, Outlook).
• Detail-oriented, process-driven, and capable of maintaining strict accuracy in high-volume workflows.

Required Qualifications

• Education: Bachelor’s degree in healthcare administration, Business, or a related field preferred.
• Strong understanding of U.S. payer credentialing and enrollment processes.
• Ability to handle multi-state provider enrollments.
• Strong analytical, time management, and problem-solving skills.
• Ability to work independently and in collaboration with U.S.-based teams.

Why Join ModuleMD?

• Work at the intersection of AI and healthcare operations, driving real-world impact.
• Be part of a fast-growing, mission-driven company revolutionizing healthcare delivery.
• Flexible remote work setup with supportive leadership and a culture of excellence.
• Opportunities to learn and grow in RCM, credentialing automation, and payer operations.
• Competitive compensation and a performance-driven environment.

Application Process

Our hiring process includes:
• Initial Screening Interview • Technical Credentialing Assessment • Final Round with the Operations & Management Team

We ensure transparent and timely communication throughout the process.

Equal Opportunity Statement

ModuleMD is an equal opportunity employer that celebrates diversity and inclusion. We welcome applicants from all backgrounds and are committed to a respectful, harassment-free workplace.

Ready to Join the Future of Healthcare Operations?

Be part of a team redefining how healthcare providers connect, enroll, and thrive in payer networks. Apply now and grow with us at ModuleMD.