Provider Enrollment & Credentialing Specialist

About pie Health

pie Health supports medical practices with provider enrollment, payer credentialing, recredentialing, revalidation, demographic changes, and resolution of payer-related issues. The company works with clients across multiple specialties and helps bring order, visibility, and steady follow-through to complex enrollment tasks involving commercial insurance carriers, Medicare, Medicaid, managed care plans, payer portals, provider rosters, and connected systems.

Role overview

pie Health is looking for a Provider Enrollment & Credentialing Specialist to assist healthcare practices with payer enrollment and credentialing activities across multiple specialties and states. This is a practical, detail-heavy position for someone who understands the nuances of provider enrollment, payer participation, credentialing documents, and persistent follow-up. The right person will be organized, responsive, careful with details, and comfortable handling enrollment work across different provider types, payers, portals, and state-specific rules.

What you will handle

• Assemble, send, track, and follow up on enrollment applications for providers, groups, facilities, and payers.
• Work with enrollment and credentialing processes in CAQH, PECOS, NPPES, Medicare, Medicaid, commercial plans, managed care organizations, payer portals, rosters, and similar systems.
• Support new enrollments, recredentialing, revalidations, demographic changes, adding providers or locations, EFT/ERA/EDI setup, and resolving payer-related problems.
• Check provider and group records for completeness and accuracy, including TINs, NPIs, licenses, malpractice coverage, board certifications, DEA details, taxonomies, locations, ownership information, and related enrollment data.
• Spot missing information, payer obstacles, incorrect connections, documentation gaps, and risks that could delay enrollment.
• Research and record payer-specific and state-specific enrollment rules.
• Communicate clearly and professionally with clients, providers, payers, and internal teammates.
• Log submissions, follow-ups, approvals, denials, open items, next steps, and deadlines in pie Health’s internal systems.
• Help interpret payer enrollment rules, submission expectations, exceptions, and escalation routes.

Experience with states and payer markets

Enrollment requirements differ by state, payer, specialty, and line of business. Candidates with experience across several states or payer markets are especially valued.

Background in state Medicaid programs, Medicaid MCOs, Medicare Administrative Contractors, commercial insurers, managed care plans, behavioral health networks, vision networks, and specialty payer arrangements is highly desirable. You do not need experience in every state or specialty, but you should be able to research requirements, record findings clearly, and adapt to different enrollment paths.

Required qualifications

• Experience in provider enrollment, payer enrollment, healthcare credentialing, or a related revenue cycle function.
• Exposure to commercial payer, Medicare, Medicaid, or managed care enrollment workflows.
• Hands-on experience with CAQH, PECOS, NPPES, payer portals, or state Medicaid portals.
• Solid understanding of how providers, groups, TINs, NPIs, locations, taxonomies, and payer participation relate to one another.
• Ability to juggle multiple priorities and keep follow-ups moving consistently.
• Strong habits around documentation and attention to detail.
• Good written and verbal communication skills.
• Ability to work remotely with reliability, ownership, and prompt responsiveness.
• Comfort using company systems, processes, and documentation standards.

Preferred qualifications

• Experience supporting healthcare organizations with multiple locations or multiple TINs.
• Exposure to behavioral health, PT/OT/ST, radiology, laboratory services, dental, urgent care, optometry, ophthalmology, or similar specialty practices.
• Familiarity with Modio, Symplr, CredentialStream, MSOW, S-Payer, or comparable credentialing tools.
• Experience with Medicare Administrative Contractors or Medicaid enrollment.
• Work involving EFT, ERA, EDI, CAQH upkeep, payer rosters, revalidations, or demographic updates.
• Credentialing certification is an advantage, though it is not mandatory.

What helps someone succeed here

• You respond quickly, work accurately, and keep the client’s needs in focus.
• You know how to keep enrollment tasks progressing instead of waiting too long to ask questions.
• You understand that good documentation is essential so others can follow enrollment status without relying on verbal updates.
• You are comfortable in a growing environment where workflows may change, systems are still being improved, and team communication matters.
• You can work independently while remaining visible and accountable to the team.
• You are willing to research payer rules, capture what you learn, and share practical knowledge with colleagues.

Role details

This is a full-time remote position with pie Health.