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Credentialing Specialist
Location
Philippines
Posted
35 days ago
Salary
0
Seniority
Mid Level
No structured requirement data.
Job Description
Credentialing Specialist
Insight Therapy Solutions
Role Description This is a remote position. As we continue to expand, we're looking for an experienced Credentialing Specialist who can help ensure our providers remain credentialed, contracted, and ready to serve patients without interruption. This role plays a critical part in supporting provider onboarding, revenue cycle performance, and organizational growth. This is an excellent opportunity for a credentialing professional who enjoys ownership, organization, and problem-solving. You'll work closely with leadership, clinical operations, billing, and provider onboarding teams to manage the full credentialing lifecycle for a growing network of behavioral health providers. If you enjoy navigating payer requirements, managing complex credentialing processes, and helping healthcare organizations scale, you'll thrive in this role. Qualifications - 2+ years of healthcare credentialing experience with U.S.-based healthcare organizations. - Hands-on experience with commercial payer credentialing and provider enrollment. - Experience managing CAQH, PECOS, NPPES, CMS, and related credentialing systems. - Strong understanding of Medicare, Medicaid, and commercial insurance credentialing processes. - Excellent organizational and documentation skills. - Strong written and verbal English communication skills. - Ability to manage multiple credentialing projects and deadlines simultaneously. - Proficiency with Google Workspace, spreadsheets, and credentialing databases. Requirements - Behavioral health or mental health credentialing experience. - Multi-state credentialing experience. - Experience with fee schedule analysis or contract negotiations. - Knowledge of revenue cycle impacts related to provider credentialing. - Experience working in a remote healthcare environment. Benefits - Paid Time Off (PTO, 10 days annually) - Paid U.S. holidays - Paid birthday leave - Parental leave - Monthly health stipend What You'll Be Responsible For - Manage initial credentialing, enrollment, and recredentialing processes for providers across commercial, Medicare, and Medicaid payers. - Prepare, submit, track, and follow up on credentialing applications through approval. - Coordinate provider onboarding activities related to payer enrollment and network participation. - Complete government payer revalidation and enrollment updates as required. - Maintain accurate provider records across CAQH, PECOS, NPPES, CMS, and other credentialing platforms. - Ensure provider files remain complete, current, and audit-ready. - Monitor credential expiration dates and proactively manage renewals. - Maintain credentialing documentation in accordance with payer and regulatory requirements. - Support provider enrollment with commercial insurance plans, Medicare, and Medicaid. - Assist with payer communications and issue resolution. - Participate in fee schedule review and contract negotiations when applicable. - Track credentialing and enrollment statuses to minimize delays in provider activation. - Partner with Clinical HR, Billing, and Operations teams to resolve credentialing-related issues impacting provider participation or reimbursement. - Communicate progress, risks, and timelines to managers and leadership. - Identify opportunities to improve credentialing workflows, processes, and tracking systems. What Success Looks Like - Provider credentialing applications are submitted accurately and completed on time. - Recredentialing and revalidation deadlines are met without lapses. - Provider onboarding timelines improve through proactive follow-up and coordination. - Credentialing-related billing denials and delays are minimized. - Leadership has clear visibility into credentialing progress and provider readiness. - Success in this role means becoming a trusted credentialing expert who helps providers join networks efficiently and supports the organization's continued growth. You'll Thrive Here If You... - Enjoy working in a highly organized and detail-oriented environment. - Take ownership of tasks and follow them through to completion. - Are proactive about solving problems before they become barriers. - Communicate effectively with providers, payers, and internal teams. - Want to contribute to the growth of a fast-moving healthcare organization.
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