Credentialing Specialist

About the Role

This position is offered by a partner organization seeking a Credentialing Specialist located in the United States. The role supports the growth of a nationwide virtual healthcare network by ensuring providers are credentialed properly to deliver compliant and efficient care.

Responsibilities include overseeing critical credentialing and payer enrollment processes that impact provider onboarding, reimbursement, and patient accessibility. This role integrates healthcare operations, compliance, payer relations, and revenue cycle collaboration within a dynamic digital care environment.

You will act as a central expert facilitating communication between providers, payers, and internal teams to streamline workflows and enhance operational performance. Operating across various states and healthcare systems, the role removes administrative obstacles to promote high-quality virtual care.

Key Responsibilities

• Handle the end-to-end processes of initial credentialing, re-credentialing, and payer enrollment for a large multi-state provider network.
• Submit, track, and maintain applications with government payers such as Medicare, Medicaid, VA, and Tricare, along with commercial insurance entities.
• Keep provider records precise in credentialing systems, payer portals, and internal databases.
• Verify credentials including education, certifications, employment history, malpractice claims, and professional references.
• Align provider enrollment activities with billing requirements to reduce claim denials and delays in reimbursement.
• Serve as a subject matter expert on credentialing procedures, payer policies, and their effects on revenue cycle management.
• Lead and mentor credentialing team members via training, quality control, and process enhancement efforts.
• Monitor timelines, payer participation, and provider listings to address enrollment challenges proactively.
• Analyze denial patterns related to credentialing and implement corrective strategies to boost efficiency.
• Ensure credentialing and enrollment are complete before scheduling patients, supporting seamless onboarding.
• Generate reports related to credentialing status, enrollment progression, expirations, and compliance for leadership review.
• Assist with audits, quality assurance, and ongoing improvement initiatives.

Candidate Requirements

• Minimum high school diploma or equivalent; Associate’s or Bachelor’s degree in Healthcare Administration or related field preferred.
• Between 5 to 7 years of experience specifically in healthcare credentialing and payer enrollment.
• Experience with telehealth services, multi-state provider networks, or virtual care platforms is highly desired.
• In-depth knowledge of government and commercial payer enrollment protocols.
• Understanding of credentialing’s impact on reimbursement and revenue cycle management.
• Proficient in using credentialing systems and payer portals like CAQH.
• Excellent organizational skills capable of managing multiple providers, payers, deadlines, and priorities effectively.
• Strong detail orientation to uphold accurate and comprehensive records.
• Effective communication skills to collaborate with diverse stakeholders including providers, payers, and internal teams.
• Ability to identify and implement process improvements in an agile, fast-paced environment.
• Self-driven, adaptable, and comfortable with independent work in a remote-first setting.

Benefits

• Fully remote position offering flexibility and autonomy.
• Opportunity to contribute to expanding healthcare access via innovative virtual care solutions.
• Work in a mission-driven organization focusing on transforming cardiovascular healthcare delivery.
• Engaged, collaborative culture fostering innovation and continuous process enhancements.
• Collaboration with healthcare professionals, operational groups, and technology teams.
• Professional development prospects within a rapidly expanding healthcare enterprise.
• Supportive and inclusive workplace valuing diverse perspectives.
• Meaningful impact on provider operations and patient health outcomes.

Additional Information

This role is presented on behalf of a partner company that manages all applications and hiring decisions. The hiring process involves artificial intelligence-assisted candidate matching but final selections and interviews are overseen by the partner's internal team.

Applicants should be aware their personal information will be processed responsibly in compliance with applicable data privacy laws. The use of AI tools aids the review and assessment process, though ultimate hiring judgments rest with human decision-makers.