Credentialing and Enrollments Specialist

Job not on LinkedIn

🔥 16 hours ago

🌵 Arizona, California, +3 more states – Remote

🌵 Arizona – Remote 🏄 California – Remote ⛰️ Colorado – Remote 🌶️ New Mexico – Remote 🌴 South Carolina – Remote

💵 $27 - $34 / hour

⏰ Full Time

🟢 Junior

🟡 Mid-level

🚫👨‍🎓 No degree required

👻 Ghost score 0%

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MODENA

WebsiteLinkedInAll Job Openings

10,000+ employees

🏥 Healthcare

👥 B2C

Healthcare • B2C

Modena is a regional healthcare provider focused on allergy, immunology and respiratory care. With multiple clinic locations across Southern California and Arizona, Modena Health offers diagnostic testing and specialized treatments for allergies, asthma, chronic sinusitis, nasal polyps, inflammatory/eosinophilic diseases, immune disorders and pediatric pulmonology. Services highlighted include oral immunotherapy (OIT), sublingual OIT, low-dose immunotherapy, allergy testing, blood testing, and ongoing patient support. The organization is led by founder Brian Modena, MD, MSc, and staffed by board-certified allergists/immunologists, pediatric specialists and respiratory clinicians; the practice also mentions involvement in clinical research and applications of AI, genetics and the microbiome to personalize care.

📋 Description

• Prepare, submit, and manage provider credentialing and payer enrollment applications for commercial, Medicare, Medicaid, and other health plans • Coordinate initial credentialing, recredentialing, and provider data maintenance for physicians and advanced practice providers • Maintain accurate provider files, including CAQH profiles, NPI information, state licenses, DEA certificates, malpractice insurance, board certifications, and other required documentation • Maintain credentialing, enrollment, and contracting records in CredentialStream and other designated databases • Monitor credentialing and enrollment statuses through payer portals and follow up to ensure timely approvals • Track expiration dates for licenses, certifications, malpractice coverage, and other required documents • Respond to payer requests for additional documentation or clarification • Communicate status updates to leadership, billing managers, clinic managers, providers, and other stakeholders • Assist with onboarding new providers, including credentialing timelines, payer enrollments, and hospital privileging requirements • Support provider offboarding, including payer terminations and record updates • Maintain confidentiality and ensure compliance with HIPAA and organizational policies • Proactively identify and resolve credentialing or enrollment delays • Maintain complete, accurate, and organized records and manage multiple provider enrollment timelines and deadlines

🎯 Requirements

• High school diploma or equivalent required • Minimum of 2 years of experience in provider credentialing, payer enrollment, medical staff services, or healthcare administration required • Working knowledge of CAQH, PECOS, NPPES, and payer enrollment portals required • Experience maintaining provider records and credentialing databases, including CredentialStream or similar credentialing software • Strong attention to detail and organizational skills • Excellent written and verbal communication skills • Ability to prioritize tasks and manage multiple deadlines effectively • Ability to work independently and collaboratively in a remote environment • Proficiency in Microsoft Office Suite, EHR systems, practice management software, and online credentialing portals • Strong problem-solving and follow-up skills • Experience with commercial and government payer enrollment processes strongly preferred • Experience with hospital privileging and provider onboarding preferred • Prior experience in allergy, asthma, or specialty medical practices is a plus • Occasional overtime may be required • Ability to stand, walk, and move throughout the clinic, if applicable, for extended periods; occasionally lift objects up to 25 lbs., bend, stoop, or reach as needed • Frequent use of hands and fingers for patient care and equipment operation • Must have normal (or corrected) vision and hearing and be able to respond quickly in a fast-paced clinical environment, if applicable

🏖️ Benefits

• Medical insurance • Dental insurance • Vision insurance • 401(k) retirement plan with employer matching • Paid time off (PTO) • Sick time • Floating holidays • Holiday pay • Competitive compensation • Professional development opportunities • Supportive, mission-focused culture