Licensing and Credentialing Specialist

This is a fully remote position, open to applicants in Arizona, +16 more states.

📋 Description

• Take charge of the complete payer enrollment procedure for both new and current providers, which includes initial enrollments, revalidations, demographic updates, terminations, and ongoing maintenance across commercial, Medicare, and Medicaid health plans.

• Submit, monitor, and actively follow up on payer enrollment applications.

• Act as the main contact point with health plans, delegated credentialing organizations, CVOs, and internal stakeholders to address enrollment challenges and escalations.

• Ensure accurate provider information is maintained across payer portals, CAQH, credentialing systems, and internal tracking tools.

• Assist with delegated credentialing activities, manage provider rosters, monitor compliance, and prepare audit documentation.

• Perform regular audits of provider enrollment and credentialing files for compliance with NCQA, CMS, state, and payer-specific requirements.

• Track enrollment and credentialing performance metrics, identify potential risks, and provide status updates to leadership and cross-functional teams.

• Collaborate with Licensing, Practice Operations, Revenue Cycle, Recruiting, and Clinical Operations teams.

• Enhance enrollment and credentialing processes through standardization, documentation, automation, and operational efficiencies.

• Assist with new state license applications, renewals, cross-licensure initiatives, and maintenance of licensure records.

• Keep track of provider licenses, DEA and CDS registrations, board certifications, malpractice coverage, and other essential credentials.

• Support providers during enrollment, credentialing, and licensing by outlining requirements, timelines, and next steps.

⛳️ Requirements

• Bachelor’s Degree in Healthcare Administration or a related field.

• Over 3 years of experience in provider payer enrollment and credentialing.

• Proven experience in managing provider enrollments with commercial, Medicare, and Medicaid payers.

• Familiarity with supporting delegated credentialing activities, including provider rosters, ongoing monitoring, or preparation for audits.

• Experience with multi-state or national provider organizations.

• Working knowledge of CAQH, payer portals, and provider credentialing systems.

• Understanding of NCQA, CMS, state licensing, and payer credentialing regulations.

• Excellent organizational skills with the capacity to manage various priorities and deadlines.

• Outstanding attention to detail along with strong written and verbal communication abilities.

• Proficiency in Google Workspace, particularly Google Sheets.

• CPCS certification or equivalent credential is preferred.

• At least 1 year of experience as a Verifiable Enrollment and Licensing Manager.

• Experience in supporting delegated credentialing audits and implementing corrective action plans.

• Familiarity with provider licensing and cross-state licensure.

• Experience collaborating with credentialing vendors (CVOs).

• Background in a virtual care or telehealth setting.

• Experience in a fast-paced, high-growth startup environment.

• A process improvement mindset with a history of documenting or optimizing workflows.

• Must currently reside and plan to continue residing throughout employment in one of the following states: Arizona, Delaware, Florida, Georgia, Idaho, Indiana, Louisiana, Michigan, Missouri, New Hampshire, New Jersey, North Carolina, Rhode Island, Pennsylvania, South Carolina, Tennessee, Texas, Vermont, Virginia, or Wisconsin.

• Work schedule is Monday to Friday, from 9 AM to 6 PM EST.

🏝️ Benefits

• Salary Range: $65,000 - $75,000 per year, with bonus eligibility.

• Employer-sponsored medical, dental, and vision insurance.

• Flexible Time Off, along with 11 paid company holidays and 1 floating holiday.

• Opportunity to contribute to a 401(k) plan.

• Remote-first work environment—operate from home within approved states.

• Customized professional development opportunities as the company grows.

• Access to Overalls, understanding that life happens.