Credentialing Specialist

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

📋 Description

• This position is tasked with the comprehensive management of provider credentialing and payer enrollment across both government and commercial payers, ensuring that providers are effectively positioned for success in a multi-state, virtual care setting.

• Oversee and execute all facets of initial credentialing, re-credentialing, and payer enrollment for an extensive network of telehealth providers throughout the U.S.

• Submit and monitor applications with government payers (Medicare, Medicaid, VA, Tricare) and commercial/private payers to guarantee active participation status.

• Provide leadership and mentorship to credentialing staff, offering training, direction, and quality assurance checks.

• Act as the subject matter expert (SME) on credentialing and payer enrollment, and their link to revenue cycle processes.

• Enhance credentialing turnaround times and minimize payer enrollment delays that could affect revenue.

• Stay informed on payer regulations and credentialing prerequisites across all states in which the organization provides telehealth services.

• Examine denial trends related to credentialing/enrollment challenges and implement corrective measures.

• Maintain accuracy of payer rosters and manage data integrity between credentialing systems and billing systems.

• Ensure provider records in credentialing systems (such as CAQH, payer portals, internal databases) are accurate, up-to-date, and compliant.

• Verify provider qualifications including education, training, board certification, work history, malpractice history, and references.

• Confirm that provider enrollment aligns with billing requirements, reducing claim denials and reimbursement delays for a seamless Revenue Cycle Management (RCM) process.

• Monitor payer rosters and enrollment timelines to proactively address issues that may affect revenue.

• Facilitate the onboarding of new providers by ensuring credentialing and enrollment are finalized prior to patient scheduling.

• Prepare reports detailing credentialing status, payer enrollment progress, and impending expirations for leadership and compliance purposes.

• Assist in audits, quality assessments, and process enhancements to ensure compliance.

⛳️ Requirements

• High school diploma or equivalent is required; an Associate’s or Bachelor’s degree in Healthcare Administration or a related field is preferred.

• 5-7 years of experience in healthcare credentialing and payer enrollment (experience in telehealth or multi-state operations is strongly preferred).

• Strong understanding of government and commercial payer enrollment requirements.

• Familiarity with Revenue Cycle Management (RCM) processes and the influence of credentialing on reimbursement.

• Proficiency in credentialing platforms and payer portals (e.g., CAQH).

• Exceptional organizational skills with the capability to manage multiple providers and payers across different states.

• A keen attention to detail, accuracy, and the ability to meet stringent deadlines.

🏝️ Benefits

• We are mission-driven: we are transforming the delivery of cardiovascular care.

• We operate in a fast-paced and agile environment: we act quickly, iterate frequently, and value experimentation.

• We embrace a remote-first approach: flexibility, autonomy, and trust are fundamental to our operations.

• We prioritize diversity: diversity helps us create an outstanding patient experience.

• We are an equal opportunity employer: we do not discriminate based on race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.