Provider Credentialing Specialist

Job Overview

We are seeking a Provider Credentialing Specialist to join a healthcare partner company based in the United States. This remote role requires expertise in managing the entire credentialing lifecycle of healthcare providers, ensuring compliance and timely enrollment so providers can deliver care without interruptions.

Key Responsibilities

• Oversee end-to-end credentialing and re-credentialing workflows from application submission through final approval.
• Gather, verify, and organize necessary documentation from providers to support credentialing and enrollment processes.
• Prepare and submit applications for both commercial and government payers.
• Complete re-credentialing tasks before provider expiration dates to maintain active status.
• Manage enrollment for NPI, PECOS, Medicare, Medicaid, and meet payer-specific credentialing requirements.
• Track and monitor credentialing applications, payer responses, approvals, and any outstanding documentation.
• Maintain and update CAQH profiles, complete attestations, and ensure provider information is current.
• Conduct monthly sanctions monitoring and keep credentialing records audit-ready.
• Proactively follow up with payers via phone and email to monitor application statuses.
• Serve as a key contact for providers, payers, and internal teams regarding credentialing inquiries.
• Identify and escalate any delays or missing information that could impact credentialing timelines.
• Assist with provider offboarding processes including notifying payers and updating records.
• Occasionally support billing and administrative duties such as claims follow-up and communications with payers.

Qualifications and Requirements

• Minimum of 2 years' hands-on experience in provider credentialing, demonstrating full process management.
• Deep understanding of CAQH, NPI enrollment, payer credentialing requirements, and enrollment procedures.
• Familiarity with Medicare, Medicaid, and commercial insurance payer systems.
• Strong communication skills with comfort in initiating proactive follow-ups by phone and email.
• Exceptional attention to detail with a proven ability to manage multiple credentialing cases simultaneously and meet deadlines.
• Proficient with Microsoft Office or Google Workspace tools.
• Reliable home office setup with stable internet access for remote work.
• Experience credentialing professionals such as Physical Therapists, Occupational Therapists, or Speech-Language Pathologists is an advantage.
• Knowledge of PECOS, CMS portals, EMR systems, or practice management software is preferable.
• Experience working with multi-state credentialing or high-volume clinics is beneficial.
• Basic understanding of billing or accounts receivable processes is a plus.
• Demonstrates ownership and persistence in managing credentialing workflows and resolving payer delays.
• Professional demeanor and effective communication when interacting with providers, payers, and leadership.

Benefits

• Competitive salary commensurate with experience.
• Full-time remote position supporting healthcare organizations across the U.S.
• Stable employment with potential for long-term career advancement.
• Opportunities for professional development within healthcare operations.
• Supportive and collaborative team environment.
• Meaningful impact by enhancing efficiency for healthcare providers.