Provider Enrollment Account Representative (non-delegated enrollment)

Provider Enrollment Account Representative (non-delegated enrollment)
Location: Remote – must live in the United States
Salary: $44,000 - $54,000 + Benefits
Benefits: Health Insurance, 401k w/ match, Paid Holidays, Paid Time Off
Job Type: Full-Time | 100% Remote
Typical Hours: 8:00 AM – 5:00 PM with flexibility, Mon-Fri
Start Date: ASAP
Sponsorship is not available

Provider Enrollment Account Representative Description

Join our client’s mission-driven healthcare team and play a key role in supporting community-based clinics across 20 US states. As an Account Representative, you will independently manage credentialing and provider enrollment activities for assigned healthcare organizations across multiple states. This includes completing and submitting individual provider enrollment applications directly with commercial, managed care, Medicare, and Medicaid payers, track payer-specific requirements, resolve enrollment issues, and follow each enrollment application through participating status and billing readiness.

You will serve as the primary point of contact for assigned accounts, partnering with medical and behavioral health providers, clinic leadership, and insurance payers to ensure providers are enrolled accurately and without unnecessary delays. This is a great opportunity to support Federally Qualified Health Centers (FQHCs), nonprofit organizations, and private practices that provide essential healthcare services to underserved communities, while growing your own caseload and career within a collaborative organization.

Provider Enrollment Account Representative Responsibilities

• Serve as the primary point of contact for assigned healthcare organizations across multiple states
  • Independently manage the full spectrum of financial credentialing and enrollment process
  • Complete and submit individual provider enrollment applications with various insurance carriers
  • Track enrollment applications through approval, participating status, and billing readiness
  • Navigate payer-specific enrollment requirements, documentation, and portal processes
  • Maintain accurate provider data, including CAQH, NPPES, and other required records
  • Monitor enrollment status, follow up with payers, and resolve delays or deficiencies
  • Coordinate provider enrollment activities with internal teams, providers, and payer representatives
  • Keep clients informed about their credentialing process status with regular progress meetings
  • Maintain accurate documentation and ensure compliance with payer and regulatory requirements

Provider Enrollment Account Representative Qualifications

• Direct provider enrollment with individual insurance payers experience required
  • Experience completing and submitting individual billable provider enrollment applications required
  • Experience managing non-delegated enrollments from submission to participating status required
  • Commercial, managed care, and Medicare/Medicaid payer enrollment experience required
  • Experience maintaining CAQH, NPPES, PECOS, and other provider data records required
  • Proficiency with credentialing/enrollment software, payer portals/systems, and Microsoft Excel required

**Candidates with primarily CVO, delegated credentialing, provider relations, or general credentialing support backgrounds are not a fit.**

Originally posted on Himalayas