State Medicaid Enrollment Specialist
A State Medicaid Enrollment Specialist navigates state-specific Medicaid programs and the Managed Care Organizations (MCOs) that administer most state Medicaid networks. Each state runs Medicaid differently. Each state contracts with different MCOs. Each MCO has its own enrollment process. The work is state-specific, complex, and increasingly essential as veteran families with Medicaid eligibility need access […]
Primary Source Verification (PSV) Specialist
A Primary Source Verification (PSV) Specialist verifies provider credentials directly from issuing authorities — state medical boards, certifying boards, educational institutions, training programs, malpractice carriers, and DEA. NCQA standards require primary source verification for credentialing files because copies, scans, and self-reported information are not sufficient to establish credential authenticity. The PSV Specialist is the role […]
CAQH Profile Manager
A CAQH Profile Manager maintains the CAQH ProView profiles that serve as the single source of credentialing truth for hundreds of payers across the United States. The Council for Affordable Quality Healthcare (CAQH) operates the universal credentialing database that practically every commercial payer and many federal payers use to pull provider credentialing data. A well-maintained […]
Payer Enrollment Specialist
A Payer Enrollment Specialist handles enrollment across multiple payers simultaneously — VA CCN, TRICARE, CHAMPVA, Medicare, Medicaid, commercial payers — coordinating the parallel application processes that get a provider active in every network the practice participates with. Where the Provider Enrollment Specialist focuses on the application work for individual providers, the Payer Enrollment Specialist focuses […]
Provider Network Coordinator
A Provider Network Coordinator builds and maintains the geographic and specialty composition of a payer’s provider network — analyzing network adequacy, identifying gaps in coverage, recruiting providers to fill gaps, and ensuring the network meets state and federal access standards. The work is strategic. The work is analytical. And it is the role where understanding […]
Provider Relations Representative
A Provider Relations Representative serves as the bridge between practices and the payer networks they participate in — handling escalations, resolving claim disputes, communicating policy changes, and building the relationships that keep practices working productively with each payer. The work is communication-heavy. The work is relationship-driven. And it is the role that turns transactional payer […]
Provider Data Specialist
A Provider Data Specialist maintains the accuracy of provider information across every directory, every payer database, and every public-facing listing where the practice’s providers appear. The work is increasingly critical as the No Surprises Act and CMS provider directory requirements impose accuracy mandates with real financial penalties. Bad provider data costs practices money. Good provider […]
Provider Enrollment Coordinator
A Provider Enrollment Coordinator manages enrollment workflow across multiple providers, multiple payers, and often multiple practices simultaneously — tracking every active enrollment application, coordinating with the Specialists who submit them, and reporting pipeline status to practice leadership. The work is operational. The work is pipeline-focused. And it is the role that scales enrollment from one […]
Provider Enrollment Specialist
A Provider Enrollment Specialist onboards credentialed providers into payer networks — submitting enrollment applications, tracking each application through review, and confirming the provider’s active status before billing begins. Where the Credentialing Specialist verifies the provider’s credentials, the Enrollment Specialist takes those verified credentials and gets them accepted into VA CCN, TRICARE, CHAMPVA, commercial payer networks, […]