Provider Enrollment/Credentialing Specialist

The Provider Enrollment/Credentialing Specialist at OMH Healthedge Holdings Inc will serve as the central liaison among providers, medical staff services, payer organizations, revenue cycle teams, and practice leadership. This role is responsible for enrolling, maintaining, and linking providers to payer systems, guaranteeing accurate billing, swift reimbursement, and adherence to all applicable regulations across the Central and West regions.

• Submit and track enrollment applications for physicians, APPs, and eligible practitioners with Medicare, Medicaid, and commercial payers.
• Maintain up‑to‑date credentialing files, ensuring all licenses, certifications, and privileging documents are current.
• Coordinate with medical staff services to verify provider privileges and resolve discrepancies.
• Monitor enrollment status dashboards and proactively address pending or denied applications.
• Communicate enrollment requirements and updates to providers and practice leadership.
• Collaborate with revenue cycle teams to ensure accurate payer linkage for billing purposes.
• Respond to payer inquiries, audits, and re‑credentialing requests in a timely manner.
• Develop and maintain standard operating procedures and documentation for enrollment processes.
• Train and support new providers on enrollment workflows and compliance expectations.
• Generate regular reports on enrollment metrics, turnaround times, and compliance status for senior management.

• Bachelor's degree in Health Administration, Business, or related field; or equivalent experience.
• 2+ years of experience in provider enrollment, credentialing, or payer relations within a hospital or health system.
• Strong knowledge of Medicare, Medicaid, and commercial payer enrollment requirements.
• Excellent organizational skills with the ability to manage multiple applications simultaneously.
• Proficiency with enrollment software platforms (e.g., CAQH, PECOS) and Microsoft Office Suite.
• Effective communication skills for interacting with providers, payers, and internal teams.
• Detail‑oriented mindset with a focus on regulatory compliance and accuracy.
• Ability to analyze enrollment data and produce actionable reports.
• Experience working in a multi‑regional or multi‑site health organization is preferred.
• Certified Provider Enrollment Specialist (CPE) or similar credential is a plus.