Credentialing Specialist
New
RemoteFull-TimeMiddle
Salary not disclosed
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Job Details
- Experience
- 5-7 years
- Required Skills
- Compliance
Requirements
- 5-7 years of experience in healthcare credentialing and payer enrollment.
- High school diploma or equivalent required; Associate’s or Bachelor’s degree in Healthcare Administration or related field preferred.
- Strong knowledge of government and commercial payer enrollment requirements.
- Familiarity with RCM processes and how credentialing impacts reimbursement.
- Proficiency with credentialing platforms and payer portals (e.g., CAQH).
- Excellent organizational skills with the ability to manage multiple providers and payers across states.
- Strong communication skills to build positive relationships with providers, payers, and internal teams.
- High attention to detail, accuracy, and ability to meet strict deadlines.
- Telehealth or multi-state experience strongly preferred.
Responsibilities
- Complete and manage all aspects of initial credentialing, re-credentialing, and payer enrollment for a large network of telehealth providers across the U.S.
- Submit and track applications with government payers (Medicare, Medicaid, VA, Tricare) and commercial/private payers.
- Lead and mentor credentialing staff, providing training, guidance, and quality checks.
- Serve as the subject matter expert (SME) for credentialing, payer enrollment, and their connection to revenue cycle processes.
- Optimize credentialing turnaround time and reduce payer enrollment delays that impact revenue.
- Maintain accurate provider records in credentialing systems (e.g., CAQH, payer portals, internal databases).
- Verify provider credentials including education, training, board certification, work history, malpractice history, and references.
- Analyze denial trends related to credentialing/enrollment issues and implement corrective actions.
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