Credentialing Specialist

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

📋 Description

• Oversee provider enrollment and credentialing: Direct the complete credentialing process for both new and existing providers, as well as practice locations — encompassing Medicare (PECOS), Medicare Advantage plans, and other payers.

• Maintain provider information: Ensure CAQH profiles are thorough, up-to-date, and accurately represent provider credentials and practice details.

• Enhance workflows: Evaluate existing credentialing procedures, pinpoint inefficiencies, and implement enhancements utilizing Airtable, automation tools, and industry best practices.

• Create SOPs: Draft, manage, and revise standard operating procedures for credentialing tasks and incorporate them into operational practices.

• Ensure compliance: Monitor credentialing statuses, re-credentialing deadlines, notifications, and plan specifications to maintain seamless provider participation in payer networks.

• Facilitate team communication: Collaborate with internal teams — including Clinical Operations, Payer Strategy, and Provider Growth — to align priorities and provide updates on credentialing advancements and obstacles.

• Provider assistance: Act as a credentialing liaison for providers and internal teams, addressing inquiries and coordinating documentation submissions.

⛳️ Requirements

• Minimum of 3 years of hands-on experience in provider enrollment and credentialing, covering both group and individual provider enrollments.

• Significant experience with PECOS enrollments, I&A, and requests for corrections – this is essential.

• Prior experience with Medicare Advantage health plans and their credentialing standards.

• Proficient in learning and utilizing tools such as Airtable, credentialing automation software, and standard office/productivity applications.

• Exceptional attention to detail, strong organizational skills, and the ability to meet deadlines in a fast-paced setting.

• Experience in developing SOPs and enhancing operational workflows.

• Capable of working cross-functionally and communicating effectively with internal teams and external stakeholders.

🏝️ Benefits

• Competitive salary

• Comprehensive benefits package, including medical insurance

• Flexible PTO and sick leave

• A friendly and dynamic team culture