Credentialing Specialist

About the Role:

• This role is responsible for end-to-end provider credentialing and payer enrollment across government and commercial payers, ensuring providers are set up for success in a multi-state, virtual care environment. The Credentialing Specialist will work closely with providers, payers, and revenue cycle teams to streamline enrollment, maintain compliance, and support timely reimbursement.
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 to ensure active participation status.
• 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
• Stay up to date on payer regulations and credentialing requirements across all states where the organization provides telehealth services
• Analyze denial trends related to credentialing/enrollment issues and implement corrective actions
• Track payer roster accuracy and manage data integrity between credentialing systems and billing systems.
• Maintain accurate provider records in credentialing systems (e.g., CAQH, payer portals, internal databases), ensuring information is current and compliant.
• Verify provider credentials including education, training, board certification, work history, malpractice history, and references.
• Ensure provider enrollment aligns with billing requirements, reducing claim denials and reimbursement delays for a streamlined Revenue Cycle Management (RCM) process
• Monitor payer rosters and enrollment timelines to proactively resolve issues that may impact revenue.
• Support the onboarding of new providers by ensuring credentialing and enrollment are completed prior to patient scheduling.
• Prepare reports on credentialing status, payer enrollment progress, and upcoming expirations for leadership and compliance purposes.
• Assist with audits, quality checks, and process improvements to ensure compliance

About You:

• You’re open to new ideas, thoughtful in your approach, pragmatic in your delivery, constantly learning, and up for a challenge. You elevate the work of those around you. You want the superpower to save millions of lives. You possess the following qualifications:
Education:
• High school diploma or equivalent required; Associate’s or Bachelor’s degree in Healthcare Administration or related field preferred.
Experience:
• 5-7 years of experience in healthcare credentialing and payer enrollment (telehealth or multi-state experience strongly preferred).
Skills:
• 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
Traits:
• High attention to detail, accuracy, and ability to meet strict deadlines

About our Culture:

Originally posted on Himalayas