Credentialing Specialist
Remote
Job Summary
Complete and manage initial credentialing, re-credentialing, and payer enrollment for a large network of telehealth providers across the U.S. Submit applications with government and commercial payers, verify credentials including education and malpractice history, and maintain accurate records in systems like CAQH. Lead and mentor staff, serve as the subject matter expert for enrollment processes, and analyze denial trends to implement corrective actions. Optimize turnaround times, track roster accuracy, and prepare reports on enrollment progress and upcoming expirations for leadership. Support provider onboarding to ensure credentialing is completed prior to patient scheduling and assist with audits to ensure compliance.
Required Qualifications
- High school diploma or equivalent
- 5-7 years of experience in healthcare credentialing and payer enrollment
- 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
Desired Qualifications
- Associate's or Bachelor's degree in Healthcare Administration or related field
- telehealth or multi-state experience
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