Licensing & Credentialing Specialist (Remote, W2)

About CareTalk Health

CareTalk Health is a virtual medical practice specializing in Clinical Process Outsourcing (CPO), partnering with healthcare organizations to manage patient and member populations across the United States.

Role Overview

The Licensing & Credentialing Specialist will handle comprehensive provider credentialing, licensing, and payer enrollment operations for a nationwide telehealth model spanning all 50 states. This position ensures that all healthcare providers and nursing staff comply with regulatory, accreditation, and payer standards while maintaining accurate and secure records in multiple systems. Additionally, this role serves as the primary resource for monitoring and applying state-specific regulatory requirements including nurse licensure monitoring and nurse practitioner collaborative agreements.

Core Responsibilities

• Manage the complete lifecycle of provider credentialing and recredentialing following CMS, NCQA, and state regulatory mandates.
• Oversee enrollment in medical payer programs, ensuring timely submissions to commercial and government payers such as Medicare.
• Administer PECOS and CMS 855i applications and updates rigorously.
• Collaborate with providers to maintain current and compliant CAQH profiles.
• Maintain accurate and confidential provider records within credentialing databases to ensure integrity.
• Track licensure status and expiration for physicians, advanced practice providers, RNs, LVNs, and LPNs using Modio, facilitating timely renewals to maintain uninterrupted practice authorization.
• Maintain up-to-date knowledge of all state telehealth licensure and practice standards, including specific nurse practitioner collaborative or supervisory requirements, and scope of practice differences by state.
• Develop and implement processes to ensure compliance with varying state laws and regulations.
• Manage collaborative agreements compliant with state requirements.
• Monitor credentialing processes closely, resolving any delays or issues with payers and regulatory bodies.
• Review credentialing applications thoroughly in alignment with accreditation standards.
• Keep provider information current across platforms such as CAQH, NPPES, PECOS, and payer portals.
• Handle sensitive data with strict adherence to HIPAA and healthcare privacy rules.
• Work collaboratively with recruiting, operations, and compliance departments for seamless provider onboarding.

Candidate Profile

• Minimum of three years’ experience in healthcare credentialing, licensing, and payer enrollment.
• Familiarity with CMS regulations, Medicare processes, and multi-state licensure requirements.
• Practical experience using CAQH, PECOS, NPPES, and various payer portals.
• Proficient in managing 855i applications and Medicare enrollment workflows.
• Experience tracking multi-state licenses and expirations for providers and nurses.
• Ability to research and apply state-specific regulations, particularly NP collaborative agreements.
• Understanding of credentialing standards including NCQA.
• Strong skills in managing credentialing databases.
• Highly organized with meticulous attention to detail.

Preferred Qualifications:

• Certification from the National Association Medical Staff Services (NAMSS), such as Certified Provider Credentialing Specialist (CPCS) or Certified Professional Medical Services Management (CPMSM).

Key Competencies

• Exceptional attention to detail and commitment to regulatory compliance.
• Effective organization and management of work processes.
• Ability to work independently in a remote setting.
• Strong analytical capabilities for regulatory research and interpretation.
• Excellent communication skills and cross-functional collaboration.

Technical Requirements

• Use either Windows (minimum Windows 10) or Apple macOS (version 14 Sonoma or higher) computer; no Chromebooks, Linux machines, or smartphones.
• Hardware requirements include Intel Core i5 or AMD equivalent processor for Windows or Apple Silicon on Macs, with 16 GB RAM.
• Wired headphones required for optimal audio quality; built-in microphones not acceptable.
• Reliable wired Ethernet internet connection with minimum 100 Mbps download and 50 Mbps upload speeds.
• Use Google Chrome browser with Amazon Workspaces software regardless of computer type.
• Webcam required for video communication; laptops with built-in webcams acceptable, otherwise external webcam necessary.
• Recommended dual monitors setup: a second monitor for laptop users or dual displays for desktop users.

Why CareTalk Health

CareTalk Health is a rapidly expanding telehealth provider delivering high-quality virtual healthcare across a national network. This role provides an opportunity to contribute to contractor operations, influence performance metrics, and support innovative clinical models in a fully remote environment.

Equal Opportunity Statement

The company is an equal opportunity employer considering all applicants regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, veteran status, or disability.

California Applicant Notice

California residents are encouraged to review the company’s California Applicant Privacy Notice detailing personal information collection, usage, retention, sharing policies and privacy rights under state law.