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Payer Enrollment & Credentialing Specialist

Payer Enrollment & Credentialing Specialist

AIS HealthcareSt. Louis, MO, US
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This is a 100% remote opportunity - Please only apply if you have experience completing payer credentialing applications .

AIS Healthcare is the leading provider of Targeted Drug Delivery (TDD) and Infusion Care with our diverse culture, and our values around Innovation, Stewardship, and Unity, we are committed to Advancing Quality, and Improving Lives. We are dedicated to doing more for our patients by providing quality products and services that enhance the entire care experience.

The Payer Enrollment & Credentialing Specialist is responsible for supporting the end-to-end payor credentialing lifecycle for a national network of specialty pharmacies and infusion centers. This includes coordinating credentialing and recredentialing processes, validating provider data, and ensuring documentation meets payor, regulatory, and accreditation standards. The role requires proficiency in credentialing platforms, data tracking systems, and cross-functional workflows to support contract execution, maintain active network status, and prevent service disruptions due to credentialing gaps.

AIS Healthcare offers great benefits, including health, vision and dental insurance, long term disability insurance, life insurance, a vacation package, 401K plan with a generous employer match, hybrid office / work from home opportunity, growth, and more! Additionally, we offer a 100% work from home model.

EDUCATION AND EXPERIENCE :

  • 3 years’ experience in completing payor credentialing applications through various methods.
  • Experience with key website / databases (i.e. NCPDP, NPPES, PECOS, CAQH)
  • Experience managing multiple applications at once and working efficiently to meet or exceed deadlines; preferably in home infusion, specialty pharmacy, and / or provider services.
  • Ability to correctly interpret and utilize provider taxonomy, NPI, and other identifiers in payor credentialing applications.

PREFERRED EXPERIENCE :

  • Medicare and Medicaid enrollment and revalidation.
  • Experience navigating contract management software preferred.

    • ESSENTIAL DUTIES AND RESPONSIBILITIES :

  • Coordinate payor credentialing and recredentialing activities for specialty pharmacies, infusion centers, and affiliated clinical providers.
  • Prepare and submit payor-specific credentialing applications, ensuring accuracy, completeness, and adherence to submission timelines.
  • Maintain organized and up-to-date documentation for pharmacy licenses, insurance, accreditations, and provider credentials required by payors within credentialing resource tool.
  • Serve as the primary point of contact with payor credentialing departments to resolve application issues, resolve delays, and ensure timely approvals.
  • Track credentialing status and milestones within Salesforce to enable proactive reporting and communicate updates to internal stakeholders.
  • Maintain detailed records and documentation required by commercial, government, and third-party payors.
  • Recognizes patients’ rights and responsibilities and supports them in the performance of job duties, respects patient’s rights to privacy and confidentiality.
  • Perform additional duties as assigned by leadership to support department goals and business priorities.

    • QUALIFICATION REQUIREMENTS :

  • Self-motivated to achieve goals and objectives
  • Demonstrate excellent organizational and time management skills.
  • Demonstrate extreme attention to detail and accuracy.
  • Customer-orientation with both internal and external customers.
  • Ability to handle multiple tasks simultaneously.
  • Results-oriented with the ability to manage priorities and projects in a fast-paced, time-sensitive environment.
  • Proficient in Microsoft Office, including Outlook, Word, and Excel.
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    Credentialing Specialist • St. Louis, MO, US

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