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 within commercial, Medicare, and Medicaid payers.

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

• Facilitate provider onboarding activities associated with payer enrollment and network participation.

• Execute government payer revalidation and enrollment updates.

• Ensure accurate provider records are maintained across CAQH, PECOS, NPPES, CMS, and other credentialing platforms.

• Keep provider files complete, up-to-date, and ready for audits.

• Track credential expiration dates and proactively manage renewals.

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

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

• Help manage payer communications and resolve issues as they arise.

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

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

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

• Report progress, risks, and timelines to management and leadership.

• Identify opportunities to enhance credentialing workflows, processes, and tracking systems.

• Ensure that applications are accurate and submitted on time, deadlines are adhered to, onboarding timelines are optimized, billing denials and delays are reduced, and leadership is informed about provider readiness.

⛳️ Requirements

• Minimum of 2 years of healthcare credentialing experience with 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.

• Comprehensive understanding of Medicare, Medicaid, and commercial insurance credentialing processes.

• Exceptional organizational and documentation abilities.

• Strong written and verbal communication skills in English.

• Capability to manage multiple credentialing projects and meet deadlines simultaneously.

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

• Experience in behavioral health or mental health credentialing.

• Multi-state credentialing experience is preferred.

• Experience in fee schedule analysis or contract negotiations.

• Knowledge of revenue cycle implications related to provider credentialing.

• Background in working within a remote healthcare environment.

🏝️ Benefits

• Paid Time Off

• Paid U.S. holidays

• Paid birthday leave