We're on a mission to deliver the most effective, efficient, and engaging heart care in the world.
Credentialing Specialist
Location
United States
Posted
5 days ago
Salary
0
Seniority
Senior
Job Description
Credentialing Specialist
Heartbeat Health
• 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. • 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.
Job Requirements
- High school diploma or equivalent required; Associate’s or Bachelor’s degree in Healthcare Administration or related field preferred.
- 5-7 years of experience in healthcare credentialing and payer enrollment (telehealth or multi-state experience strongly preferred).
- 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
- High attention to detail, accuracy, and ability to meet strict deadlines
Benefits
- We are mission-driven: we're revolutionizing the way cardiovascular care is delivered
- We are fast-paced & agile: we move quickly, iterate often, and value experimentation
- We are remote-first: flexibility, autonomy, and trust are at the core of how we operate
- We care about diversity: diversity allows us to build an excellent patient experience
- We are an equal opportunity employer: we do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status
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