Pearl Talent connects top talent with leading startups. We are seeking a Contracting & Credentialing Specialist (A198) to manage the full lifecycle of provider contracting and credentialing across a growing healthcare services network. You will own the accuracy, compliance, and timeliness of provider credentialing and payer contract maintenance to enable clean claims, audit readiness, and scalable growth.
What You'll Do
- Maintain complete and compliant credentialing files for all providers.
- Prepare, submit, and track credentialing and re-credentialing applications across payers and networks.
- Monitor credentialing timelines, expirations, and documentation requirements to prevent lapses.
- Resolve payer discrepancies or requests for additional documentation.
- Review, negotiate, and manage payer contracts to ensure favorable terms and alignment with organizational standards.
- Maintain an updated database of active contracts, renewal dates, fee schedules, and amendments.
- Research and resolve payer issues related to enrollment, contracting, or rate configuration.
- Collaborate cross-functionally with billing, operations, and RCM teams to maintain billing readiness and compliance.
- Assist with billing-related tasks including claim follow-up, enrollment-related denials, and payer verification.
- Coordinate with revenue cycle and operations teams to investigate issues linked to credentialing or contracting status.
- Support process improvements that enhance billing accuracy, provider enrollment efficiency, and payer communication.
What We're Looking For
- Minimum of 2 years of experience in contracting, credentialing, or a related revenue cycle management role.
- Familiarity with payer and provider-side operations within the U.S. healthcare system.
- Strong understanding of insurance verification, payer enrollment, and provider data management.
- Exceptional attention to detail, organization, and follow-up.
- Proficiency in Microsoft Office and credentialing/RCM software platforms.
Nice to Have
- Experience in ABA (Applied Behavior Analysis) or behavioral health settings.
- Knowledge of CAQH, NPI registry, and major insurance portals.
- Background in both payer and provider-side RCM operations.
Technical Stack
- Microsoft Office Suite
- Credentialing or provider enrollment platforms
- Insurance payer portals
- Shared drives and document management systems
- CAQH ProView
- NPI/NPPES registry tools
- Healthcare-specific contract management systems
- RCM or enrollment workflow software
Team & Environment
You will collaborate cross-functionally with billing, operations, and RCM teams.
Benefits & Compensation
- Competitive Salary based on experience and skills
- Fully remote work
- Performance Bonus based on data accuracy, reporting timeliness, and overall sales efficiency
- Team Incentives for maintaining 100% CRM hygiene and on-time reporting
- Generous PTO in accordance with company policy
- Health Coverage for PH-based talents: HMO coverage after 3 months for full-time employees
- Direct Mentorship from international industry experts
- Learning & Development resources for professional growth
- Global Networking opportunities
Work Mode
This role is fully remote and open to candidates in specific regions: LATAM (Mexico City, Bogotá, São Paulo, Buenos Aires) and the Philippines (Manila, Cebu, Davao).
Pearl Talent is an equal opportunity employer.
