Credentialing Specialist

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

📋 Description

• Oversee the initial credentialing, enrollment, and recredentialing processes for providers across commercial, Medicare, and Medicaid payers.

• Prepare, submit, monitor, and follow up on credentialing applications until approval.

• Coordinate provider onboarding activities concerning payer enrollment and network participation.

• Complete updates for government payer revalidation and enrollment as required.

• Maintain precise provider records across CAQH, PECOS, NPPES, CMS, and other credentialing platforms.

• Ensure that provider files are complete, up-to-date, and ready for audits.

• Keep track of credential expiration dates and proactively manage renewals.

• Maintain credentialing documentation in compliance with payer and regulatory standards.

• Assist with provider enrollment in commercial insurance plans, Medicare, and Medicaid.

• Help manage payer communications and resolve any issues that arise.

• Participate in fee schedule reviews and contract negotiations when necessary.

• Monitor credentialing and enrollment statuses to reduce delays in provider activation.

• Collaborate with Clinical HR, Billing, and Operations teams to address credentialing-related issues affecting provider participation or reimbursement.

• Communicate updates, risks, and timelines to managers and leadership.

• Identify areas for improvement in credentialing workflows, processes, and tracking systems.

⛳️ Requirements

• A minimum of 2 years of healthcare credentialing experience with U.S.-based healthcare organizations.

• Practical experience with commercial payer credentialing and provider enrollment.

• Experience managing CAQH, PECOS, NPPES, CMS, and other related credentialing systems.

• Strong knowledge of Medicare, Medicaid, and commercial insurance credentialing processes.

• Excellent organizational and documentation abilities.

• Strong written and verbal communication skills in English.

• Ability to handle multiple credentialing projects and deadlines concurrently.

• Proficiency in Google Workspace, spreadsheets, and credentialing databases.

🏝️ Benefits

• Paid Time Off (PTO, 10 days annually)

• Paid U.S. holidays

• Paid birthday leave

• Parental leave

• Monthly health stipend