[Hiring] Home Care Credentialing & Provider Enrollment Specialist @Quality Home Care
Role Description We are seeking an experienced Home Care Credentialing & Provider Enrollment Specialist to manage provider credentialing and payer enrollment activities. This role ensures that our agency remains actively credentialed, compliant, and eligible for reimbursement across Medicare, Medicaid, and commercial insurance networks. You will work closely with operations and billing teams to maintain accurate provider records and support our growth initiatives.
- Maintain and update CAQH ProView profiles for all providers.
- Complete initial and re-credentialing applications with Medicare, Medicaid, and commercial payers.
- Track enrollment status, follow up with payers, and ensure timely approvals.
- Maintain credentialing files, audit documentation, and compliance reports.
- Collaborate with operations and billing teams to support reimbursement and network participation.
- Monitor expiration dates and manage re-credentialing processes.
- Act as a liaison between providers, payers, and internal teams to resolve credentialing issues.
Qualifications
- 2+ years of provider enrollment or healthcare credentialing experience, preferably in non-skilled home care in the state of Michigan.
- Strong knowledge of CAQH ProView, Medicare PECOS, Medicaid portals, and commercial payer systems.
- Excellent attention to detail, organization, and follow-up skills.
- Ability to manage multiple tasks and meet deadlines.
- Strong verbal and written communication skills.
- Experience with credentialing software or tracking systems is a plus.
Preferred Qualifications
- Prior experience with non-skilled home care licensing requirements in the state of Michigan.
- Knowledge of provider contracting and network participation.
- Familiarity with auditing credentialing and compliance documentation specifically in the state of Michigan.
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