Insurance Credentialing Specialist

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

📋 Description

• Oversee the complete credentialing lifecycle, which includes initial payer enrollment, contracting, recredentialing, revalidation, and continuous payer participation across various payers and states.

• Prepare, submit, and monitor applications from the initial submission phase through to approval and confirmed effective dates.

• Develop and sustain CAQH ProView profiles, covering initial setup, attestations, and reattestations.

• Ensure the accuracy and consistency of provider information across CAQH, payer portals, and internal records.

• Maintain comprehensive and up-to-date provider files, encompassing NPI Type 1 and Type 2, taxonomy codes, state licenses, DEA registrations, board certifications, malpractice insurance, as well as provider demographics and practice information.

• Submit and manage Medicare enrollment through PECOS.

• Complete enrollments with state Medicaid programs and managed-care plans, in addition to commercial and behavioral health payers.

• Track pending, incomplete, returned, and rejected applications, following up proactively through payer portals and provider-enrollment phone lines.

• Resolve enrollment issues and ensure applications are followed through to an approved effective date.

• Maintain a centralized credentialing tracker and deliver weekly status updates.

• Monitor upcoming deadlines for recredentialing, revalidation, licenses, certifications, and other expirations to avoid lapses.

• Escalate payer-related delays or issues when necessary.

• Collaborate with billing to verify payer enrollment and effective dates, ensuring claims are submitted only after a provider is fully active.

• Keep credentialing documentation accurate, organized, and ready for audits.

⛳️ Requirements

• Practical experience with CAQH ProView.

• Practical experience with NPPES / NPI Registry.

• Practical experience with PECOS for Medicare enrollment.

• Practical experience with state Medicaid provider portals.

• Practical experience with commercial payer portals, including Availity and payer-specific systems.

• Familiarity with provider credentialing and payer enrollment procedures.

• Understanding of taxonomy codes and provider enrollment documentation.

• Knowledge of payer-specific enrollment and credentialing regulations.

• Demonstrated experience in provider credentialing and payer enrollment.

• Strong comprehension of Medicare, Medicaid, commercial, and behavioral health payer enrollment.

• Exceptional attention to detail and documentation management skills.

• Strong follow-up abilities and persistence when dealing with payers.

• Capacity to manage multiple providers, payers, states, and deadlines concurrently.

• Excellent organizational and time-management capabilities.

• Ability to detect missing or inconsistent information before it leads to enrollment delays.

• Comfortable communicating with payer representatives and provider enrollment departments.

• Self-motivated and capable of managing the credentialing process with minimal oversight.

🏝️ Benefits

• Competitive hourly wage.

• Timely payments, guaranteed.

• Payments processed through Wise.

• Direct training provided by clients.

• Assigned Account Manager as your main point of contact.

• Stable, long-term placement with a growing U.S.-based company.

• Exposure to a variety of modern SaaS platforms.

• Opportunities for increased responsibilities as the company expands.

• Recognition for tenure among long-term team members.

• Clear paths for escalation.

• 100% remote — work from home.

• Supportive team culture across all accounts.

• Potential for increased hours or additional accounts based on performance.

• Enhance your U.S. industry experience.

• Exposure to multiple practice types and platforms.

• Strengthen your resume with verified, legitimate U.S. client experience.

• Acknowledgment for loyalty and long-term growth.