Credentialing/Payor Enrollment Specialist

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

📋 Description

• Oversee the payor enrollment process in partnership with the Director of Credentialing Operations.

• Facilitate clinical onboarding and continuous enrollment, ensuring that clinical providers are enrolled and renewed with health plans.

• Gather and maintain accurate and up-to-date information for all clinical providers.

• Manage credentialing documents in databases, ensuring timely enrollment and re-credentialing.

• Conduct primary source verification during the initial credentialing and re-credentialing processes.

• Keep copies of enrollment forms, applications, and necessary documentation.

• Maintain payor enrollment delegation rosters, updating them for new hires and former providers.

• Collaborate with HR to ensure new providers are enrolled in health plans prior to their start date.

• Assist new hires with Medicaid and Medicare applications, including reassigning Medicare benefits to Brave Health.

• Address inquiries from new hires regarding payor enrollment and credentialing procedures.

• Ensure that current credentialing documentation is submitted during onboarding for primary source verification.

• Work with vendors that support payor enrollment processes.

• Investigate new payor enrollment opportunities to improve network participation.

• Promote process and tool enhancements as organizational needs change.

• Identify opportunities for increased efficiency, including outsourcing or implementing new technology.

⛳️ Requirements

• A minimum of three years of relevant experience in credentialing or payor enrollment is required.

• Strong understanding of Medicaid, Medicare, and private payer insurance systems.

• Highly organized, with the ability to effectively multitask and manage competing priorities.

• Capable of working under pressure and adapting to the dynamic, fast-paced environment of a startup.

• Strong orientation towards tools and automation; proactive in seeking, assessing, and recommending new technologies and tools to improve scalability and efficiency.

• NAMSS CPMSM or CPCS certification is preferred.

• Leadership experience in managing credentialing or payor enrollment teams or driving significant process improvements is preferred.

• An Associate’s or Bachelor’s degree in Healthcare, Business Administration, or a related field is preferred.

• Experience with remote work is strongly preferred.

• Familiarity with Medicaid, Medicare, and commercial/private payers.

• Experience with credentialing or payor enrollment platforms and databases such as CAQH, PECOS, NPPES, and state-specific Medicaid portals.

• Experience collaborating with external vendors or partners to facilitate credentialing or payor enrollment processes.

• Background in a healthcare startup, multi-state telehealth, or other fast-paced, rapidly growing healthcare settings.

• At least one year of professional experience in a fully remote role is requested in the application form.

🏝️ Benefits

• Comprehensive health, dental, and vision coverage.

• Generous paid time off, including parental leave.

• Fully remote, work from home position.

• All equipment provided.