Credentialing and Payor Enrollment Analyst

This is a fully remote position, open to applicants in United States.

📋 Description

• Take charge of the complete onboarding process for new providers, from the moment they accept the offer until they are ready to practice.

• Recredential existing providers to ensure compliance and continuity in their practice.

• Gather, review, and verify documentation related to education, training, work history, certifications, and malpractice coverage.

• Prepare and submit enrollment applications to payors and other necessary entities.

• Monitor the status of applications, follow up proactively, and address any deficiencies.

• Prepare, submit, and track initial and renewal applications for state licenses across various jurisdictions.

• Stay informed about state-specific licensing requirements and their timelines.

• Keep track of license expirations, renewals, and compliance deadlines.

• Communicate with state boards and regulatory agencies regarding inquiries, requests, or discrepancies.

• Submit new payor enrollment and re-enrollment applications for commercial, Medicare, and Medicaid payors.

• Complete payor-specific forms, attestations, and updates regarding provider status.

• Prepare and submit rosters for payors.

• Monitor enrollment progress and escalate issues related to billing or reimbursement risks.

• Maintain organized records for credentialing, licensing, and enrollment.

• Communicate timelines, status updates, and potential risks to internal stakeholders and providers.

• Utilize structured workflows, checklists, and documentation standards for managing high volumes of work.

• Identify areas of inefficiency and suggest improvements to processes.

⛳️ Requirements

• A minimum of 5 years of experience in healthcare credentialing, licensing, and payor enrollment, particularly in multistate operations.

• Experience in creating and managing CAQH accounts.

• Exceptional attention to detail and the ability to handle complex workflows laden with documentation.

• Strong organizational and time-management skills, capable of managing multiple providers and deadlines effectively.

• Clear and structured written and verbal communication abilities.

• Experience in a startup, growth-stage, or fast-paced healthcare setting.

• Preferred experience in credentialing and enrolling advanced practice providers and/or physicians.

• Familiarity with commercial, Medicare, and Medicaid payors is preferred.

• Experience in supporting provider onboarding at scale or within high-growth organizations is preferred.

• Familiarity with credentialing and enrollment platforms, payer portals, or compliance tracking tools is preferred.

• Must be legally authorized to work in the United States.

• Requirements for visa sponsorship must be disclosed.

🏝️ Benefits

• Comprehensive medical, dental, and vision plans fully covered for you and your dependents.

• Flexible paid time off (PTO).

• 11 paid holidays each year.

• 401(k) plan with company matching contributions.

• 16-week parental leave policy for the birthing parent.

• 8 weeks of parental leave for all other parents.

• Contributions to Health Savings Accounts (HSA) and Flexible Spending Accounts (FSA).

• Life insurance coverage.

• Short- and long-term disability coverage.