Credentialing & Payer Enrollment Specialist Location:

Santa Ana, California

THIS POSITION IS 100

%

IN-OFFICE. THERE IS NO OPPORTUNITY FOR REMOTE OR HYBRID WORK.

ProMedix Health is seeking a detail-oriented Credentialing & Payer Enrollment Specialist to manage provider credentialing and payer enrollment across our multi-state Remote Patient Monitoring (RPM) and Chronic Care Management (CCM) practice. This role is responsible for enrolling and credentialing our providers with Medicare, Medicaid, and commercial payers across 20+ states, supporting negotiation of commercial payer contracts, and ensuring our clinicians remain compliant with CMS, state, and payer requirements, working alongside our outside credentialing partner during the transition to an in-house function. Additionally, this role will support RCM. Responsibilities Manage the full credentialing and recredentialing lifecycle for physicians, nurse practitioners, and other clinical staff across all states where ProMedix operates Manage multi-state provider enrollment across the full payer mix: Medicare (PECOS), Medicaid (state-specific portals), and commercial payers, maintaining accurate CAQH ProView profiles throughout Support negotiation of commercial payer contracts, including gathering rate and network data, tracking contract status and renewal timelines, and coordinating with payer representatives on terms Conduct and track primary source verification (licensure, education, board certification, malpractice history, sanctions/exclusions checks) Track license renewals, expirables, and multi-state licensure requirements to prevent lapses in active practice authority Coordinate with Medicare, Medicaid, and commercial health plans on provider enrollment status, panel participation, contract effective dates, and re-credentialing cycles Maintain accurate, audit-ready credentialing and payer enrollment files consistent with NCQA credentialing standards Serve as the internal liaison to our outside credentialing firm during the transition to in-house credentialing and payer enrollment operations Support internal compliance and clinical operations leadership on credentialing-related audits, payer inquiries, and CMS requirements specific to RPM and CCM programs Support RCM, including billing and claim review and resubmittals Flag credentialing, enrollment, or contracting gaps, delays, or compliance risks proactively to leadership Qualifications Minimum 3 years of credentialing experience covering provider credentialing and payer/health plan enrollment across Medicare, Medicaid, and commercial payers Direct experience with commercial payer contracting or network development strongly preferred (rate negotiation exposure, contract tracking, or payer relations) Certified Provider Credentialing Specialist (CPCS) designation preferred; candidates actively pursuing certification will be considered Hands-on experience with PECOS, state Medicaid enrollment portals, and CAQH ProView required Experience with multi-state licensure and enrollment tracking; multi-state experience strongly preferred given our 20+ state footprint Familiarity with NCQA credentialing standards Experience in telehealth, RPM, CCM, or Medicare Advantage settings is a plus Strong proficiency in Microsoft Excel and Word; comfort working within credentialing and contract-tracking databases Exceptional attention to detail, organizational skills, and ability to manage competing deadlines across multiple states and payers High level of discretion in handling confidential provider, payer, and contract information

Compensation & Benefits Expected Pay Range:

$26.00 to $35.00 per hour, depending on experience, certification status, and payer contracting background Health, dental, and vision insurance 401(k) Paid time off and holidays Disclosure Benefits are per Company Plan. The exact starting compensation to be offered will be determined at the time of selecting an applicant for hire, in which a wide range of factors will be considered, including but not limited to, skillset, years of applicable experience, education, references, education and credentials. Employment is at-will. Offers may be contingent on background checks per California

ICRAA/FCRA.

Pay:

$26.00 - $35.00 per hour Expected hours: 30.0 - 40.0 per week

Benefits:

401(k) Dental insurance Health insurance Vision insurance Application Question(s): The position is 100% on-site in Santa Ana, CA. There is no opportunity for remote or hybrid work. Do you reside within 30 miles of Santa Ana, CA? Do you have a CPCS certification that is active and in good standing?

Work Location:

In person