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 nationwide model. We are seeking a high-level, strategic National Payer Enrollment & Contract Negotiation Specialist to architect, build, and maintain our nationwide payer network, allowing us to bill for sleep services across all 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 commercial contracts, and open closed insurance panels. You will be responsible for ensuring that our corporate structure, Type 2 NPIs, and multi-state provider networks are seamlessly aligned so we can legally and profitably bill for sleep diagnostics nationally.

Key Responsibilities

• National Network Expansion: Lead the end-to-end strategy and execution for securing commercial, Medicare, and select multi-state Medicaid contracts across national markets.
• Contract Negotiation: Go beyond basic form-filling to negotiate favorable fee schedules, master network agreements, and multi-state contracts with major national payers (UHC/Optum, Aetna, Cigna, Anthem/BCBS, Humana).
• Sleep Medicine & IDTF Alignment: Manage credentialing complexities unique to Independent Diagnostic Testing Facilities (IDTFs) and Place of Service (POS) 12 (Home-Based) national billing models.
• Panel Penetration: Formulate and present aggressive "network justification narratives" and appeal packets to force open closed payer panels in targeted, high-priority 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 Integrity: Manage national group profiles across CAQH ProView (multi-location group setups), Medicare PECOS (multi-jurisdictional enrollment), NPPES, and Availity.
• Implementation & Revenue Transition: Oversee the transition from "Contract Approved" to "Claims Active" by managing the electronic enrollment workflows (EDI, ERA, EFT) with national clearinghouses to prevent revenue leakage.

Ideal Qualifications

• Experience: Minimum 5–7 years of dedicated experience in U.S. multi-state or national payer enrollment and group contract negotiation.
• Niche Expertise: Prior, proven success credentialing for Sleep Medicine, Home Sleep Testing (HST), Durable Medical Equipment (DME), IDTFs, or nationwide Telehealth networks is highly preferred.
• System Mastery: Expert-level proficiency with PECOS (CMS-855B forms), CAQH, NPPES, and complex multi-state Availity 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 presence capable of negotiating directly with payer network managers.

Schedule & Environment

• Location: 100% Virtual / Work From Home
• Hours: Monday to Friday (Aligned 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
• Vision insurance

Work Location: Remote