Top 3 Provider enrollment specialist Jobs in Silver Spring, Md

Enrollment Provider & Credentialing Consultant
Solutions Technology, Inc / STI Health & Wellness —Odenton, MD
- $23.89 - $28.51 an hour
- Part-time
- Mid-level
- High school diploma or GED
- Bachelor's degree
Medical Credentialing Specialist
Cirrus iNtegrated Practice Management —Ashburn, VA
- Full-time
- Mid-level
- Office
- 1 year
- Profit sharing
- AD&D insurance
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Client Success Associate
Maryland Business Associates —College Park, MD
Identify referral opportunities and develop new commercial relationships within the local business community. Conduct in-person or scheduled business visits to…
$1,000 - $1,500 a week
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Research Nurse Specialist
A-Team Solutions —Bethesda, MD
O Active, current license as a Registered Nurse in the United States*, the Commonwealth of Puerto Rico, or a territory of the United States.
$100,000 - $135,000 a year
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Provider Enrollment Specialist-Day(FT)
Adena Health System —Chillicothe, OH
Minimum Qualifications Required Educational Degree: High School Diploma or GED Major/Area of Concentration: Preferred Education: Associates Degree in Business…
Insurance Credentialing Specialist
TOTAL CARE THERAPY LLC —Dublin, OH
Associate's or Bachelor's degree in Healthcare Administration, Business, or a related field. Verify provider credentials and ensure compliance with payer, state…
$50,000 - $65,000 a year
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Enrollment Provider & Credentialing Consultant

Solutions Technology, Inc / STI Health & Wellness
Odenton, MD

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Job Details

Part-time
$23.89 - $28.51 an hour

Qualifications

Electronic health records (EHR) management
High school diploma or GED

Full Job Description

Job Summary
This is an independent contractor role. The Insurance Provider Enrollment and Credentialing Specialist manages the administrative process of enrolling healthcare providers into commercial and government health insurance networks. This role conducts comprehensive background verifications to ensure all clinical staff meet regulatory, licensing, and accreditation standards. This vital role ensures clinicians are legally permitted to practice, properly affiliated with commercial and governmental payers, and authorized to submit claims for patient care. The Specialist acts as the primary liaison between clinicians, medical billing teams, and health insurance payers to ensure uninterrupted reimbursement for patient care.

Salary Requirements
$49,700 - $59,300 ($23.89 - $28.51 per hour)
Contract Part-Time, Onsite

Core Responsibilities

Credential Verification: Verify provider medical licenses, board certifications, DEA registrations, education, and malpractice insurance.
Network Enrollment: Compile, complete, and submit detailed payer applications, track them to ensure completion, and resolve issues that prevent a provider from gaining "in-network" status with commercial insurance plans. Obtain and manage practice locations and provider rosters. Enroll individual clinicians and group practice in:
- Tricare, BCBS CareFirst, AETNA, CIGNA, United Healthcare, and other commercial payers as needed
Database Maintenance: Update and maintain accurate provider profiles in national databases and registries including CAQH and NPPES.
Tracking & Follow-up: Monitor the status of pending applications with payers to ensure timely network approval and prevent credentialing gaps. Respond to payer request for additional information.
Compliance Management: Ensure compliance with payer and regulatory requirements. Track expiration dates for provider licenses, certificates, and insurances to ensure continuous compliance. Maintain enrollment records and approval dates.
Re-Credentialing & Revalidation Cycle: Proactively update files and renew applications to maintain compliance with changing state, federal (CMS), and accrediting (NCQA/TJC) regulations. Manage the routine re-credentialing and revalidation processes mandated by insurers and regulatory bodies.
Issue Resolution: Investigate and resolve enrollment delays, provider data errors, and credentialing-related billing rejections.
Cross-Department Collaboration: Partner with HR, legal, clinicians, and billing/coding to streamline provider onboarding.
Contract Coordination
- Work with payer representatives during the contracting process
- Ensure contracts are executed and effective dates are recorded
- Track reimbursement schedules and network participation status

Key Qualifications:

Education: High school diploma or GED required; bachelor’s degree in healthcare administration or a related field preferred.
Experience: Minimum of 2–4 years of direct experience in medical credentialing and payer enrollment.
Systems Proficiency: Hands-on experience using CAQH ProView, NPPES, and electronic medical record (EMR) software.
Regulatory Knowledge: Deep understanding of NCQA and Joint Commission credentialing guidelines and compliance standards.
Skill Set: Exceptional attention to detail, strong organizational skills, and excellent written and verbal communication abilities.

Preferred Qualifications

Certification: Certified Provider Credentialing Specialist (CPCS) or Certified Professional Medical Services Management (CPMSM) designation.
Payer Network: Established relationships or familiarity with regional commercial health plan provider relations departments.

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provider enrollment specialist jobs in silver spring, md

Enrollment Provider & Credentialing Consultant

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