Credentialing & Provider Enrollment Specialist

Behavioral Health Hospital Billing

We are hiring a Credentialing & Provider Enrollment Specialist to manage provider credentialing, payer enrollment, and compliance processes for behavioral and mental health providers, including hospital-based programs and individual clinicians. The ideal candidate should have strong experience handling commercial and government payer enrollments while ensuring providers remain fully credentialed and billing ready.

Key Responsibilities

• Manage provider credentialing and payer enrollment with commercial payers, Medicare, and Medicaid
• Maintain and update CAQH profiles with timely attestations
• Process CMS 855B / 855I enrollments and PECOS updates
• Handle Group NPI (Type 2) and Individual NPI (Type 1) setup and NPPES linkage
• Verify provider licenses, DEA/CDS certificates, malpractice insurance, and credential documents
• Coordinate hospital privileges, accreditation documents, and behavioral health compliance requirements
• Track recredentialing timelines, payer effective dates, and enrollment status
• Maintain credentialing trackers, payer matrices, and follow-up reports
• Perform payer follow-ups and resolve enrollment discrepancies or application rejections
• Support multi-state telehealth provider credentialing when required

Required Qualifications

• 2+ years of credentialing or provider enrollment experience
• Strong knowledge of CAQH, NPPES, PECOS, and payer portals
• Experience with commercial payer and CMS enrollments
• Understanding of behavioral health or hospital credentialing workflows
• Strong attention to detail, organization, and deadline management
• Ability to manage multiple enrollments and follow-ups simultaneously

Preferred Qualifications

• Experience in Behavioral Health, IOP, PHP, or inpatient psychiatry credentialing
• Familiarity with JCAHO/CARF standards and hospital medical staff processes
• CPCS or CPMSM certification is a plus

This role is ideal for someone who understands the operational impact of credentialing accuracy and can help maintain compliant, revenue-ready provider enrollment operations.