Credentialing & Enrollment Specialist

Company: Advantixx RCM
Location: Las Vegas
Posted on: February 16, 2026

Job Description:

Job Description Job Description Description: KEY RESPONSIBILITIES Credentialing & Provider File Management - Manage initial credentialing and ongoing re-credentialing for providers across all payer networks. - Maintain complete and accurate provider credentialing files, including licenses, DEA, NPI, board certifications, malpractice, CVs, and supporting documents. - Track credentialing deadlines, expiration dates, and renewal requirements to prevent lapses in participation. - Maintain and update CAQH profiles, including attestations and supporting documentation. Payer Enrollment & Contracting Support - Complete and submit payer enrollment applications for Medicare, Medicaid, and commercial payers. - Manage payer portal registrations and provider demographic setup (TIN/NPI linking, locations, specialties, taxonomy codes). - Ensure EFT and ERA enrollment is completed for all payers and maintain updated banking information as needed. - Coordinate with payers to resolve enrollment delays, requests for additional information, and application errors. - Support contracting tasks by gathering information, tracking effective dates, and maintaining payer participation records. Revalidation & Ongoing Updates - Manage Medicare and Medicaid revalidation processes and ensure all timelines are met. - Submit and track provider and organization updates (address changes, new locations, ownership changes, providers added/terminated). - Assist with payer audits and credentialing verification requests. - Maintain accurate logs for payer communications, status updates, and submitted documentation. Compliance & Quality - Ensure compliance with payer requirements, state/federal guidelines, and internal policies. - Ensure credentialing and enrollment records are kept secure and HIPAA compliant. - Verify provider eligibility to bill prior to start dates and ensure all approvals are received before scheduling/billing as required. Reporting & Workflow Management - Maintain a credentialing/enrollment tracking system and provide weekly/monthly status reports to leadership. - Monitor turnaround times and identify bottlenecks in payer enrollment workflows. - Develop and improve SOPs, checklists, and templates to increase efficiency and reduce errors. Collaboration - Coordinate with billing, HR, clinical leadership, and operations to ensure providers are credentialed prior to rendering services. - Work closely with billing to resolve payer enrollment issues affecting claim submission or reimbursement. Requirements: REQUIRED QUALIFICATIONS - 2 years of credentialing and payer enrollment experience in healthcare (clinic, home health, behavioral health, multi-specialty, etc.). - Strong knowledge of Medicare, Medicaid, and commercial payer enrollment processes. - Experience managing CAQH, PECOS (preferred), and payer portals. - Strong attention to detail and ability to manage multiple provider files at once. - Excellent written and verbal communication skills. - Proficiency in Microsoft Office (Excel preferred) and credentialing tracking systems. PREFERRED QUALIFICATIONS - Experience with Medicare/Medicaid revalidations and ownership updates. - Experience credentialing multiple provider types (MD/DO, APRN, PA, LCSW, LMFT, etc.). - Knowledge of accreditation requirements (CHAP, ACHC, Joint Commission) is a plus. - Credentialing certification (NAMSS CPCS/CPMSM) is a plus. - Bilingual (English/Spanish) is a plus. SKILLS & COMPETENCIES - Highly organized with strong follow-through and time management - Strong understanding of payer requirements and credentialing documentation - Ability to communicate professionally with payer representatives - Ability to work independently with minimal supervision - Strong problem-solving and escalation skills - Confidentiality and professionalism with sensitive provider information WHAT SUCCESS LOOKS LIKE IN THIS ROLE - Providers enrolled and credentialed accurately and on time - Minimal billing delays due to credentialing issues - Clean, well-maintained provider files and tracking logs - Fast resolution of payer requests and enrollment issues - Accurate reporting and proactive communication with leadership

Keywords: Advantixx RCM, Henderson , Credentialing & Enrollment Specialist, Administration, Clerical , Las Vegas, Nevada