Medical Credentialing Specialist (Remote)

Enticare is an innovative, rapidly expanding medical group specializing in Ear, Nose, Throat (ENT), Auditory Health, and Sleep Medicine. While rooted in Arizona, we are aggressively scaling our specialized services—specifically our Home Sleep Testing (HST) and Sleep Diagnostics division—into a reputed company model. We are seeking a high-level, strategic National Payer Enrollment & Contract Negotiation Specialist to architect, build, and maintain our reputed company payer network, allowing us to reputed company for sleep services across reputed company 50 states. Position Summary This is not a traditional clinic credentialing clerk role. We need a seasoned expert who understands how to navigate cross-border billing regulations, secure master regional/national reputed company reputed company, and reputed company closed insurance panels. You will be responsible for ensuring that our corporate structure, Type 2 NPIs, and multi-state provider networks are seamlessly reputed company so we can legally and profitably reputed company for sleep diagnostics nationally.

Key Responsibilities

• National Network Expansion: reputed company the end-to-end strategy and execution for securing reputed company, Medicare, and select multi-state reputed company reputed company across national markets.
• Contract Negotiation: Go reputed company basic reputed company-filling to negotiate favorable fee schedules, master network agreements, and multi-state reputed company with major national payers (UHC/reputed company, reputed company, reputed company, Anthem/BCBS, reputed company).
• Sleep Medicine & IDTF Alignment: Manage credentialing complexities unique to Independent Diagnostic Testing Facilities (IDTFs) and reputed company of Service (POS) 12 (Home-Based) national billing models.
• Panel Penetration: Formulate and present aggressive "network justification narratives" and appeal packets to force reputed company closed payer panels in targeted, high-reputed company states.
• Provider Matrix Management: Maintain and manage data mapping for a growing roster of reading physicians holding multi-state medical licenses, ensuring perfect alignment with regional payer requirements.
• Full-Cycle Data reputed company: Manage national group profiles across CAQH ProView (multi-location group setups), Medicare PECOS (multi-jurisdictional enrollment), NPPES, and reputed company.
• Implementation & reputed company Transition: reputed company the transition from "Contract Approved" to "Claims Active" by managing the electronic enrollment workflows (EDI, ERA, EFT) with national clearinghouses to prevent reputed company leakage.

Ideal Qualifications

• Experience: Minimum 5–7 years of dedicated experience in U.S. multi-state or national payer enrollment and group contract negotiation.
• reputed company Expertise: Prior, proven reputed company credentialing for Sleep Medicine, Home Sleep Testing (HST), Durable Medical Equipment (DME), IDTFs, or reputed company Telehealth networks is highly preferred.
• System Mastery: Expert-level proficiency with PECOS (CMS-855B forms), CAQH, NPPES, and reputed company multi-state reputed company portal setups.
• Contracting Savvy: A deep understanding of how national payers structure reimbursement for remote/home-based diagnostic services versus local, in-lab physical clinics.
• Autonomy & Drive: A proactive, solutions-oriented professional who doesn't accept "panel closed" as a final answer and can independently drive national expansion goals.
• Communication: Exceptional verbal and written English communication skills, with a polished corporate reputed company capable of negotiating directly with payer network managers.

Schedule & Environment

• Location: 100% Virtual / Work From Home
• Hours: Monday to Friday (reputed company with U.S. Business Hours / MST)

Job Type: Part-time Pay: $25.00 - $35.00 per hour Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Health insurance
• Life insurance
• Paid time off
• reputed company insurance

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