Payer Enrollment & Credentialing Specialist

🔥 3 minutes ago

🇵🇭 Philippines – Remote

💵 $5 - $6 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

✨ Enrollment Specialist

👻 Ghost score 9%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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Winning Assistants LLC

WebsiteLinkedInAll Job Openings

51 - 200 employees

💼 Consulting

📣 Marketing

📦 Logistics

Consulting • Marketing • Logistics

Winning Assistants LLC is a staffing and recruiting company that provides virtual assistants from the top 1% of the global talent pool. They specialize in helping doctors, healthcare professionals, and business owners save time, reduce costs, and scale operations with highly skilled, HIPAA-compliant virtual assistants. Their services include admin support, medical office management, marketing, and customer service, allowing clients to focus on growth.

📋 Description

• Prepare, complete, and submit provider enrollment applications to commercial insurance payers, Medicare, Medicaid, and other health plans. • Manage payer enrollment applications from initial submission through approval and effective date. • Follow up with insurance companies regarding pending applications, missing documentation, corrections, and enrollment status. • Respond to payer requests for additional information or documentation. • Track submissions, reference numbers, effective dates, payer decisions, and outstanding requirements. • Maintain payer enrollment through demographic changes, practice location updates, provider additions, terminations, and other updates. • Identify enrollment delays or issues and work with payers and internal teams toward resolution. • Maintain accurate provider participation and payer enrollment records. • Manage initial credentialing and re-credentialing requirements. • Collect, review, organize, and maintain provider credentialing documents. • Verify NPI, licenses, certifications, education, work history, malpractice coverage, and other credentials. • Audit provider files for missing, inaccurate, outdated, or expired documentation. • Monitor expiration and renewal dates and follow up on required documentation. • Prepare and submit credentialing and re-credentialing applications within required timelines. • Maintain complete, audit-ready credentialing files. • Resolve credentialing discrepancies or incomplete applications. • Maintain provider information across credentialing and payer systems, applications, payer portals, and internal records. • Maintain trackers for pending, completed, and outstanding applications. • Document payer communications and follow-up activities. • Communicate with providers and internal stakeholders about documentation, application updates, and enrollment requirements. • Escalate credentialing or enrollment issues when necessary.

🎯 Requirements

• Hands-on experience with payer enrollment and provider credentialing is strongly preferred. • Experience completing and submitting healthcare provider enrollment applications. • Familiarity with commercial payers, Medicare, and/or Medicaid enrollment processes. • Experience managing credentialing or enrollment applications from submission through approval. • Experience with provider credentialing documentation, including NPI, professional licenses, certifications, malpractice insurance, and other provider records. • Experience with initial credentialing and re-credentialing workflows. • Experience communicating and following up directly with insurance payers regarding application status and outstanding requirements. • Familiarity with credentialing platforms, payer portals, and provider databases is highly preferred. • Experience maintaining credentialing/enrollment trackers and managing multiple deadlines simultaneously. • Previous healthcare administrative or Medical VA experience is preferred. • Strong understanding of provider credentialing and payer enrollment processes. • Highly organized and detail-oriented, with strong documentation and tracking skills. • Able to independently follow up on pending applications without constant supervision. • Strong problem-solving skills for payer delays, missing documentation, or application discrepancies. • Excellent written and verbal English communication skills. • Comfortable communicating professionally with insurance representatives, providers, and internal teams. • Able to manage multiple providers, payers, applications, and deadlines simultaneously. • Commitment to accuracy, confidentiality, and HIPAA compliance. • Must speak and write English clearly and professionally. • Must have relevant work experience. • Must provide an NBI Clearance and/or Local Police Clearance before onboarding. • Must attend video meetings with camera on when required. • Reliable laptop or desktop computer. • Stable high-speed internet connection of at least 25 Mbps. • Noise-canceling headset. • Working webcam. • Quiet and professional work environment.

🏖️ Benefits

• Dedicated HR & Contractor Support Team: Access to world-class support for questions, guidance, contract matters, and client communication. • Premium VPN Access (Optional): A secure VPN license can be provided upon request to enhance privacy and security for client-related tasks. • HIPAA & Cybersecurity Training + Certification (Provided): Access to internal HIPAA compliance training, cybersecurity modules, and certification. • Top 1% VA Performance Training: Proprietary training on communication, client management, productivity systems, and best practices. • Client-Approved U.S. Holidays: Contractors may take U.S. holidays off according to the client’s needs and schedule. • Client-Approved Paid or Unpaid Time Off: Time off may be granted by the client; paid time off is optional and only if offered by the client. • Access to Tools & Resources: Templates, workflow guides, productivity tools, and client-specific SOP support. • Optional Performance-Based Incentives: Some clients may offer bonuses, incentives, or increased hours based on performance. • Independent contractor perks and client-approved allowances.