Part-Time Provider Enrollment & Credentialing Specialist - CAQH, PECOS, NPPES

Genesis Pain Clinic is a US-based interventional pain management clinic looking for an experienced part-time Provider Enrollment & Credentialing Specialist.

This is not a general VA role.
This is not an entry-level healthcare admin role.
This is not basic insurance verification.

This is a credentialing, payer enrollment, provider enrollment, and compliance tracking role.

We are a small specialty medical clinic with one physician provider and one primary clinic location. We need someone who can organize and maintain credentialing, payer enrollment, CAQH, PECOS, NPPES, license renewals, DEA renewals, hospital/surgery center privileges, and payer follow-up.

Initial workload may be 5-10 hours per week while we clean up existing files, update profiles, and resolve open credentialing issues.

Long-term maintenance may average 5-10 hours per month, depending on payer recredentialing, license renewals, hospital privileges, and new enrollment needs.

Pay:
$8-$12 USD per hour depending on verified experience.

Schedule:
Part-time, flexible schedule.
Must be available for scheduled check-ins.
Paid time must be focused only on our credentialing work.

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REQUIRED EXPERIENCE
------------------------------------------ ---------- to 5 years of US healthcare credentialing or provider enrollment experience
- Hands-on CAQH experience
- Hands-on PECOS / Medicare provider enrollment experience
- NPPES / NPI update experience
- Commercial payer enrollment experience
- Experience submitting and tracking payer applications
- Experience following up with payers by portal, email, and phone
- Experience maintaining credentialing trackers or spreadsheets
- Strong written English
- Strong attention to detail
- Ability to work independently
- High confidentiality and professionalism

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STRONGLY PREFERRED EXPERIENCE
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- Physician practice credentialing
- Specialty clinic credentialing
- Pain management, anesthesia, orthopedic, spine, PM&R, neurology, ASC, or procedural-specialty experience
- Hospital or surgery center privileging
- Medicare and Medicaid enrollment
- Commercial payer enrollment with BCBS, UHC/Optum, Aetna, Cigna, Humana, and regional payers
- EFT / ERA / EDI enrollment
- Payer contracting support
- Recredentialing and revalidation
- Workers' Compensation network enrollment
- Experience handling sensitive provider disclosures, malpractice history, training gaps, licensure questions, or application explanations
- CPES, CPCS, CPMSM, CPB, CPC, or other healthcare credentialing/billing certification

Certifications are preferred but not required.
Real hands-on credentialing experience matters more than certificates.

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MAIN RESPONSIBILITIES
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You may be responsible for:

- Maintaining CAQH profile
- Uploading and updating CAQH documents
- CAQH attestations / re-attestations
- Authorizing payer access in CAQH
- Maintaining PECOS / Medicare enrollment information
- Tracking Medicare revalidations
- Maintaining NPPES / NPI information
- Updating taxonomy, address, contact, and practice information
- Submitting commercial payer enrollment applications
- Tracking payer application status
- Following up with payers until approval
- Confirming payer effective dates
- Supporting payer contracting paperwork
- Supporting EFT / ERA / EDI setup
- Helping connect payer approvals to billing/clearinghouse workflow
- Tracking payer portal logins and status updates
- Maintaining a credentialing tracker
- Maintaining a license / DEA / CME / malpractice renewal calendar
- Assisting with hospital and surgery center privilege applications
- Tracking hospital reappointment deadlines
- Organizing peer references and privilege documents
- Organizing malpractice insurance certificates and loss runs
- Organizing board certification, CME, ACLS/BLS, and other documents
- Organizing sensitive disclosure documents for provider review
- Preparing weekly or monthly status reports

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CONFIDENTIALITY REQUIREMENT
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This role involves sensitive physician credentialing information.

You may see private information related to medical licenses, malpractice history, training history, insurance applications, hospital privileges, DEA registration, government portals, and payer applications.

You must be extremely confidential.

You may not:

- Share clinic or provider information
- Save documents to your personal computer
- Upload documents to your personal Google Drive, Dropbox, or email
- Forward clinic documents to outside accounts
- Upload clinic documents into ChatGPT, Gemini, Claude, or any outside AI tool without written approval
- Share logins
- Subcontract the work
- Allow another person to access our documents or portals

A confidentiality agreement and HIPAA/BAA may be required before access is granted.

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SENSITIVE DISCLOSURE RULE
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Some credentialing applications ask sensitive yes/no questions about malpractice claims, training history, licensure history, hospital privileges, investigations, or professional issues.

You are not expected to make legal or professional judgment calls.

Your responsibility is to:

- Flag every sensitive disclosure question
- Organize the requested information
- Draft a clear factual summary if asked
- Send the question and draft to the physician for review
- Wait for physician approval before submission
- Never guess
- Never hide information
- Never answer a sensitive question without approval
- Never submit an application with incomplete or inaccurate disclosure information

Accuracy, honesty, and confidentiality are mandatory.

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TRACKING AND REPORTING
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Every application or follow-up must be documented.

Your credentialing tracker should include:

- Payer or facility name
- Portal used
- Application type
- Date started
- Date submitted
- Confirmation number
- Reference number
- Contact person
- Current status
- Missing items
- Next follow-up date
- Approval date
- Effective date
- EFT / ERA / EDI status if applicable
- Notes and blockers

A short weekly status report will be required.

Weekly report should include:

- Applications submitted
- Applications pending
- Payers or facilities contacted
- Reference numbers obtained
- Missing documents needed from physician
- Sensitive disclosure questions needing physician review
- Renewals coming due
- Problems or delays
- Next week priorities

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WORK STYLE
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This is a part-time role, but paid time must be focused on our work.

During paid working time:

- You must work only on our credentialing tasks
- You may not bill time while working for another client
- You may not subcontract the work
- You must document actual work completed
- You must update the credentialing tracker
- You must be available for scheduled check-ins
- You must be able to explain what you completed

This role is best for someone who is organized, detail-oriented, experienced, confidential, and able to work independently.

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DO NOT APPLY IF
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Please do not apply if:

- You have no US healthcare credentialing experience
- You have never used CAQH
- You have never used PECOS
- You do not understand provider enrollment
- You only know insurance verification
- You only know medical billing but not credentialing
- You cannot maintain a detailed tracker
- You are not comfortable with sensitive confidential information
- You need to be trained from the beginning
- You cannot follow up with payers consistently
- You cannot work independently
- You plan to subcontract this role
- You are not willing to complete a live screen-share skills test

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SELECTION PROCESS
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Qualified applicants may be asked to complete:

- Written screening questions
- Short video interview
- Live screen-share workflow test
- Credentialing tracker review
- Paid trial task
- 30-day probationary period

We are not hiring based on interview confidence.

We are hiring based on demonstrated credentialing skill, organization, confidentiality, and follow-through.

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HOW TO APPLY
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Your application will only be considered if you follow these instructions.

The first line of your application must be:

CREDENTIALING EXPERT - CAQH PECOS

Then answer these questions:

1. How many years of US healthcare credentialing or provider enrollment experience do you have?

2. Have you personally worked in CAQH? Describe exactly what tasks you performed.

3. Have you personally worked in PECOS? Describe exactly what tasks you performed.

4. Have you personally updated NPPES / NPI information? What types of updates have you done?

5. Which commercial payers have you credentialed providers with?
Examples: BCBS, UHC/Optum, Aetna, Cigna, Humana, Medicare Advantage plans, Medicaid plans, regional payers.

6. Have you handled hospital or surgery center privilege applications? If yes, describe your experience.

7. Have you handled Medicare revalidation, Medicaid enrollment, or payer recredentialing? Give examples.

8. Have you handled EFT / ERA / EDI enrollment after payer approval? Explain your workflow.

9. What credentialing tracker or spreadsheet have you used? Describe the columns you would include.

10. Describe a time when a payer application was stuck, returned incomplete, or delayed. What did you do to fix it?

11. Have you ever handled sensitive provider disclosures such as malpractice history, training gaps, licensure questions, or disciplinary questions? How did you handle confidentiality and provider approval?

12. What certifications do you have, if any?
Examples: CPES, CPCS, CPMSM, CPB, CPC, healthcare administration, medical billing, credentialing training.

13. Are you currently working for other clients? If yes, list your current schedule and confirm that you will not bill us while working for another client.

14. What is your requested hourly rate in USD?

15. Are you available for a live screen-share test where you walk through a sample CAQH / PECOS / payer enrollment workflow?

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MINI TEST QUESTION
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A solo physician is already in-network with some payers, but the CAQH profile, NPPES profile, malpractice certificate, DEA certificate, and payer enrollment tracker may be outdated.

Walk me through exactly how you would audit and clean up the credentialing file during the first 30 days.

Your answer should mention CAQH, PECOS, NPPES, payer applications, commercial payers, Medicare, DEA, state license, malpractice insurance, hospital privileges, EFT / ERA / EDI, credentialing tracker, missing documents, and follow-up schedule.