Licensing & Credentialing Specialist
C
CareTalk HealthTelehealth
United StatesFull-TimeMiddle
Salary30 USD per hour
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Job Details
- Experience
- 3+ years
- Required Skills
- HIPAA
Requirements
- 3+ years of experience in healthcare credentialing, licensing, and payer enrollment.
- Strong knowledge of CMS regulations, Medicare enrollment processes, and multi-state licensing requirements.
- Hands-on experience with CAQH, PECOS, NPPES, and payer portals.
- Experience managing 855i applications and Medicare provider enrollment workflows.
- Demonstrated experience tracking multi-state licensure and expirations for providers and nursing staff.
- Experience researching and applying state-specific regulatory requirements, including NP collaborative agreements.
- Knowledge of credentialing standards including NCQA.
- Strong database management experience within credentialing systems.
- Windows or macOS computer (no Chromebooks or Linux).
- Minimum 100 MBPS download / 50 MBPS upload internet speed with ethernet connection.
- Wired headphones with no built-in mics.
- Certification from NAMSS (CPCS or CPMSM) is preferred.
Responsibilities
- Manage full-cycle provider credentialing and recredentialing processes in compliance with CMS, NCQA, and state regulatory requirements.
- Oversee medical payer enrollment activities, including submission of applications to commercial payers and government entities.
- Complete and manage PECOS and CMS 855i enrollments and updates.
- Maintain and track provider records and licensure expiration dates using Modio, ensuring data integrity and confidentiality.
- Research and interpret state-specific regulations, including Nurse Practitioner collaborative agreement requirements.
- Coordinate and manage collaborative agreements in accordance with state-specific requirements.
- Maintain provider data across platforms including CAQH, NPPES, PECOS, and payer portals.
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