Licensing & Credentialing Specialist

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

📋 Description

• Oversee the complete provider credentialing and recredentialing processes, ensuring compliance with CMS, NCQA, and state regulatory standards.

• Supervise medical payer enrollment activities, guaranteeing timely and precise submission of applications to commercial payers and government entities such as Medicare.

• Handle and manage PECOS and CMS 855i enrollments and updates efficiently.

• Collaborate with providers to maintain and update CAQH profiles, ensuring accuracy and compliance with attestation requirements.

• Maintain and monitor provider records within credentialing databases, ensuring data integrity, accuracy, and confidentiality.

• Track and manage active licenses and expiration dates through Modio for:

• Physicians and Advanced Practice Providers

• Registered Nurses (RNs)

• Licensed Vocational Nurses (LVNs)

• Licensed Practical Nurses (LPNs)

• Proactively oversee expiration dates and coordinate renewals via Modio to ensure continuous compliance and practice capability.

• Keep an up-to-date understanding of licensure and practice requirements across all 50 states that affect telehealth delivery.

• Conduct research and interpret state-specific regulations, including:

• Requirements for Nurse Practitioner collaborative/supervisory agreements

• Variations in scope of practice by state

• Establish and uphold processes to ensure adherence to varying state laws and updates in regulations.

• Coordinate and manage collaborative agreements in accordance with the specific requirements of each state.

• Monitor credentialing status and proactively address issues or delays with payers and regulatory agencies.

• Perform thorough reviews of credentialing applications in accordance with NCQA and accreditation standards.

• Maintain provider data across various platforms including CAQH, NPPES, PECOS, and payer portals.

• Keep comprehensive databases of provider information, ensuring both accuracy and confidentiality.

• Handle sensitive information with strict compliance to HIPAA and healthcare privacy regulations.

• Collaborate across functions with recruiting, operations, and compliance teams to ensure timely onboarding.

⛳️ Requirements

• A minimum of 3 years of experience in healthcare credentialing, licensing, and payer enrollment.

• Strong understanding of CMS regulations, Medicare enrollment processes, and multi-state licensing requirements.

• Practical experience with CAQH, PECOS, NPPES, and payer portals.

• Proven experience managing 855i applications and workflows for Medicare provider enrollment.

• Demonstrated ability to track multi-state licensure and expiration for providers and nursing staff, including RNs, LVNs, and LPNs.

• Experience in researching and applying state-specific regulatory requirements, including those for NP collaborative agreements.

• Knowledge of credentialing standards, particularly NCQA.

• Strong database management skills within credentialing systems.

• Exceptional organizational abilities with a keen eye for detail.

🏝️ Benefits

• 100% Remote