About the Role
This role is responsible for managing the credentialing and enrollment lifecycle for healthcare providers, ensuring compliance with payer standards and timely onboarding into insurance networks.
Responsibilities
- Verify provider licenses, certifications, and professional history
- Submit and track provider applications to insurance payers
- Maintain accurate records in credentialing databases
- Follow up on pending enrollment cases to prevent delays
- Respond to inquiries from providers and insurance carriers
- Ensure compliance with NCQA, CMS, and state-specific regulations
- Coordinate with internal teams to resolve documentation issues
- Monitor credentialing timelines and meet service level agreements
- Update provider information in internal and external systems
- Assist with re-credentialing and periodic file reviews
- Manage provider enrollment in Medicare, Medicaid, and commercial plans
- Identify and resolve discrepancies in application materials
- Prepare and submit required forms such as W-9s and CAQH updates
- Serve as a point of contact during payer audits
- Support the onboarding of new provider types and specialties
- Maintain confidentiality of sensitive provider data
- Stay current with payer policy changes and industry standards
- Escalate complex cases to senior credentialing staff
- Generate reports on enrollment status and completion rates
- Improve processes to reduce credentialing cycle times
Nice to Have
- Prior experience in a fast-paced healthcare startup
- Direct experience with delegated credentialing entities
- Exposure to value-based care networks
- Background in patient access or provider relations
- Familiarity with EHR integrations in enrollment workflows
Compensation
Competitive salary and benefits package
Work Arrangement
Remote position with flexible hours
Team
Part of a growing healthcare operations team focused on provider onboarding
Why This Role Matters
- Accurate and timely credentialing ensures providers can see patients and get paid without delays.
- This role directly impacts provider satisfaction and network completeness.
- Efficient enrollment supports rapid scaling of clinical services.
What You’ll Bring
- A meticulous approach to documentation and compliance.
- Proactive communication when resolving enrollment barriers.
- Adaptability in a dynamic regulatory environment.
Not available
