Credentialing Specialist

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

📋 Description

• Oversee the initial credentialing, recredentialing, and payer enrollment for physicians, advanced practice providers, and other licensed healthcare professionals.

• Administer Medicare, Medicaid, and commercial payer enrollment applications across various states.

• Conduct primary source verifications and revalidations.

• Submit and oversee updates to provider demographics, location additions, participation requests, and other enrollment modifications.

• Track applications until completion and follow up with payers to address any delays or discrepancies.

• Maintain provider credentialing files, databases, and reporting systems.

• Regularly monitor and update CAQH, PECOS, NPPES, Availity, and state enrollment systems.

• Manage expirations for licenses, DEA registrations, malpractice insurance, board certifications, attestations, and other credentials.

• Ensure compliance with Holon Health policies, NCQA standards, CMS requirements, and state and federal regulations.

• Prepare documentation necessary for audits, accreditation reviews, and payer credentialing requests.

• Assist with provider onboarding and the expansion into new markets.

• Maintain provider rosters and coordinate submissions to participating health plans.

• Address credentialing inquiries from providers, health plans, regulatory agencies, and internal stakeholders.

• Oversee credentialing inboxes and daily workflows, including approvals, denials, appeals, and payer correspondence.

• Collaborate with Operations, Leadership, Contracting, and Compliance teams.

• Identify opportunities for process improvements to enhance efficiency, accuracy, and turnaround times.

⛳️ Requirements

• Minimum of five (5) years of experience in healthcare credentialing, provider enrollment, medical staff services, or a related field.

• Preferred Bachelor’s degree in Healthcare Administration, Business Administration, or a related discipline.

• Equivalent experience will be taken into account.

• Comprehensive understanding of credentialing and recredentialing processes, payer enrollment workflows, and primary source verification.

• Experience working with Medicare, Medicaid, and commercial health plans.

• Proven experience in managing credentialing and enrollment processes across multiple states.

• Proficient in credentialing systems, provider portals, and Microsoft Office applications.

• Strong organizational abilities, meticulous attention to detail, and commitment to follow-through.

• Demonstrated ownership and accountability for producing accurate, audit-ready work.

• Capable of managing multiple priorities and adhering to deadlines in a fast-paced environment.

• Excellent written and verbal communication skills with providers, payers, and internal teams.

• Familiarity with Modio or another credentialing database is a plus.

• Experience in telehealth or integrated healthcare models is an advantage.

• Background in developing and implementing delegated credentialing processes is desirable.

🏝️ Benefits

• Unlimited PTO

• Flexible schedules

• Remote-first culture

• Health insurance

• Dental insurance

• Vision insurance

• Life insurance

• Disability insurance

• 401(k) with company match

• Space for self-care

• Opportunities for growth in a high-impact, mission-driven startup

• A team that celebrates achievements, learns from setbacks, and offers support.