Payer Credentialing Specialist

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

📋 Description

• Oversee the entire credentialing and recredentialing processes for both new and existing providers, ensuring verification of their education, training, board certifications, and professional experience.

• Facilitate the completion of payer enrollment applications and updates for prompt processing and provider participation across both commercial and governmental payers.

• Keep credentialing files and records accurate and up-to-date, adhering to internal standards and regulatory mandates.

• Collaborate with providers, health plans, and internal teams to address and resolve credentialing challenges and delays.

• Monitor credentialing timelines and proactively follow up on pending applications and required documentation.

• Ensure adherence to NCQA, CMS, state, and payer-specific regulations and standards.

• Engage in audits, surveys, and reporting pertaining to provider credentialing and enrollment.

• Assist clinical operations, revenue cycle, and human resources teams with credentialing-related information and processes.

⛳️ Requirements

• At least 1 year of experience in provider credentialing and payer enrollment, ideally within a multi-state medical group or healthcare organization.

• Candidates with less than 1 year of experience are welcome to apply if they feel they are a suitable match.

• Strong sense of ownership and the capability to work independently in a remote setting.

• Exceptional accuracy and attention to detail.

• Systematic approach to managing applications, deadlines, and documentation.

• Dependable follow-through and the ability to recognize and escalate potential delays.

• Direct and clear communication skills.

• Excellent time management skills, with the ability to juggle multiple credentialing tasks and deadlines simultaneously.

• Familiarity with CAQH, NPPES, and PECOS is a plus.

• Must have current authorization to work in the United States.

• Should address potential employment visa sponsorship needs for work in the United States.

🏝️ Benefits

• Medical, dental, and vision insurance.

• 401K retirement plan with company matching.

• Up to 20 days of paid time off (PTO) annually, in addition to company holidays.

• Up to 14 weeks of parental leave (12 weeks for non-birthing parents).

• Annual work-from-home stipend for remote employees.

• Fully remote position.