Payor Credentialing and Enrollment Specialist (50951)

Description

Payor Credentialing & Enrollment Specialist

Job Summary

Capitol Imaging Services, we’re a leading provider of diagnostic imaging services committed to delivering high-quality patient care through innovation and a compassionate approach. Our high-quality radiology services include—MRI, CT, PET/CT, Nuclear Medicine, ultrasound, X-ray, and mammography. We are currently operating 60 facilities across six states in the Gulf Coast region.

The Payor Credentialing & Enrollment Specialist is responsible for managing facility and provider enrollment with government and commercial payers to support accurate participation, clean claims, and timely reimbursement. This fully remote role owns payor enrollment submissions, revalidations, credentialing documentation, payer portal maintenance, effective-date tracking, and ongoing enrollment compliance. The position also works closely with billing, revenue cycle, and operational leadership to resolve enrollment-related denials, address reimbursement delays, reduce avoidable write-offs, and strengthen workflows that prevent recurring payor setup and participation issues.

Key Responsibilities

Payor Enrollment, Participation & Revenue Cycle Support

• Manage enrollment-related workflows that support timely payor participation, accurate payer setup, clean claim submission, and appropriate reimbursement.
• Research and resolve enrollment-driven denials, non-payment, effective-date discrepancies, payer participation issues, and reimbursement delays across modalities, payors, and sites
• Develop practical solutions that prevent recurring credentialing, enrollment, payor participation, and claims-processing issues
• Convert denial and reimbursement trends into actionable enrollment workflows, payer-specific guidance, and standard operating procedures
• Conduct payor follow-up to resolve missing documentation, application deficiencies, effective-date issues, participation discrepancies, claim denials, and payment variances.
• Investigate and resolve enrollment or payer setup issues causing delays in payment or reimbursement to support accurate claims processing
• Partner with revenue cycle teams to identify recurring denial patterns and recommend enrollment-focused process improvements that reduce AR delays and avoidable write-offs
• Monitor enrollment-related accounts receivable issues and escalate payor participation or credentialing barriers that impact reimbursement

Credentialing, Application Management & Enrollment Maintenance

Collect, verify, and maintain facility and provider documentation required for credentialing, enrollment, contracting support, and payor participation

Prepare, submit, and track initial enrollment, revalidation, re-credentialing, demographic update, and payor maintenance applications in accordance with organizational, payor, and regulatory requirements

Maintain accurate and complete electronic credentialing files

Track credential expiration dates and proactively manage renewals to prevent lapses

Complete and submit provider enrollment applications for Medicare, Medicaid, and commercial payors

Manage enrollments using CAQH, PECOS, NPPES, and payor-specific portals

Conduct regular follow-ups with payors to resolve delays, missing documentation, or application deficiencies

Confirm provider participation status and effective dates with each payor

Maintain current payor fee schedule information and communicate payer setup or reimbursement concerns to appropriate revenue cycle stakeholders.

Maintenance & Compliance

• Update payors with changes to provider demographics, locations, group affiliations, and tax information
• Ensure ongoing compliance with federal, state, and payor requirements
• Maintain documentation for audits and internal reviews
• Partner with billing, revenue cycle, operations, and leadership teams to resolve credentialing- or enrollment-related claim issues and prevent recurring reimbursement disruption

Remote Work Expectations

• Maintain reliable internet access and a secure, HIPAA-compliant remote work environment
• Communicate effectively with internal teams via email, phone, and virtual meetings
• Manage workload independently while meeting deadlines and productivity expectations

Qualifications

Required

Experience in healthcare payor enrollment, provider or facility credentialing, enrollment maintenance, reimbursement support, or revenue cycle operations; radiology or diagnostic imaging experience preferred

5+ years of experience in provider credentialing, payor enrollment, application tracking, enrollment maintenance, payor follow-up, and denial or reimbursement issue resolution

Strong knowledge of Medicare, Medicaid, and commercial insurance enrollment processes

Demonstrated ability to research enrollment-related claim denials, resolve reimbursement delays, reduce avoidable write-offs, and recommend process improvements

Ability to manage multiple providers and deadlines independently in a remote setting

Excellent written and verbal communication skills

Skills & Competencies

• Highly detail-oriented and deadline-driven
• Comfortable with frequent payor follow-up, payer portal research, documentation tracking, enrollment status monitoring, and revenue cycle issue resolution
• Proficient with Microsoft Office and web-based systems
• Self-motivated and able to work independently in a remote environment
• Always maintains confidentiality and professionalism