Credentialing Specialist – Part-time

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, track, and follow up on credentialing applications until approval is received.

• Coordinate onboarding activities for providers related to payer enrollment and network participation.

• Complete updates for government payer revalidation and enrollment.

• 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.

• Monitor credential expiration dates and proactively handle renewals.

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

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

• Facilitate payer communications and resolve any issues that arise.

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

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

• Collaborate with Clinical HR, Billing, and Operations teams to address credentialing-related challenges.

• 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 experience in healthcare credentialing within U.S.-based healthcare organizations.

• Practical experience with commercial payer credentialing and provider enrollment.

• Familiarity with managing CAQH, PECOS, NPPES, CMS, and related credentialing systems.

• Strong understanding of the credentialing processes for Medicare, Medicaid, and commercial insurance.

• Excellent organizational and documentation capabilities.

• Strong written and verbal communication skills in English.

• Ability to handle multiple credentialing projects and meet deadlines simultaneously.

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

• Experience in behavioral health or mental health credentialing.

• Background in multi-state credentialing.

• Experience in fee schedule analysis or contract negotiations.

• Understanding of the revenue cycle effects related to provider credentialing.

• Experience working in a remote healthcare setting.

🏝️ Benefits

• Paid Time Off

• Paid U.S. holidays

• Paid birthday leave