Remote Credentialing Specialist Jobs in the US

Find remote credentialing specialist opportunities with fresh hourly updates. Open to US candidates.

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13 Jobs

13 Companies

Payor Credentialing Specialist

Echo AI (acquired by Calabrio)

The first generative AI-native Conversation Intelligence platform that turns customers feedback into insights.

Credentialing Specialist1 day ago

Full Time Remote SeniorTeam 51-200H1B No Sponsor

Company Site LinkedIn

• Coordinate the credentialing, recredentialing, and provider enrollment process for physicians, advanced practice providers, and allied health professionals. • Complete, review, and submit credentialing and enrollment applications to Medicare, Medicaid, commercial insurance carriers, and managed care organizations. • Monitor application status, follow up with payors, and resolve deficiencies to ensure timely provider enrollment. • Verify provider credentials, including licensure, education, training, certifications, work history, malpractice coverage, and other required documentation. • Maintain provider records in credentialing databases: MD Staff, CAQH, PECOS, NPPES, and other applicable systems, enabling tracking of credential expiration dates and maintenance of audit-ready files. • Coordinate with providers and internal departments to obtain required documentation and respond to requests from payors for additional information. • Research and resolve credentialing and enrollment issues affecting provider participation and reimbursement. • Generate credentialing reports, maintain enrollment status reports, and support internal and external audits. • Ensure compliance with federal and state regulations, accreditation standards, HIPAA, and organizational policies; communicate credentialing status updates to leadership and providers. • Participate in process improvement initiatives. • Willingness to work occasional nights and weekends with up to 25% of travel required.

View details: Payor Credentialing Specialist

Colorado

$21 - $28 / hour

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Licensing and Credentialing Specialist

Connecting for Better Health

Advancing data sharing to improve the health of all Californians

Credentialing Specialist2 days ago

Full Time Remote SeniorTeam 1-10Since 2021H1B No Sponsor

Company Site LinkedIn

• Own the end-to-end payer enrollment process for new and existing providers, including initial enrollments, revalidations, demographic updates, terminations, and maintenance across commercial, Medicare, and Medicaid health plans. • Submit, track, and proactively follow up on payer enrollment applications to ensure timely provider participation and minimize delays to patient care and revenue. • Serve as the primary point of contact with national and local health plans, delegated credentialing organizations, CVOs, and internal stakeholders to resolve enrollment issues, missing information requests, and payer escalations. • Maintain accurate provider data across payer portals, CAQH, credentialing systems, and internal tracking tools, ensuring consistency across all platforms. • Support delegated credentialing activities by maintaining provider rosters, submitting required updates, monitoring compliance requirements, and preparing documentation for internal and external audits. • Conduct routine audits of provider enrollment and credentialing files to ensure compliance with NCQA, CMS, state, and payer-specific requirements. • Monitor key enrollment and credentialing metrics, identify risks to provider participation, and communicate status updates and timelines to leadership and cross-functional partners. • Collaborate closely with Licensing, Practice Operations, Revenue Cycle, Recruiting, and Clinical Operations teams to ensure providers are fully credentialed, enrolled, and ready to see patients on schedule. • Identify opportunities to improve enrollment and credentialing workflows through process standardization, documentation, automation, and operational efficiencies. • Support provider licensing activities as needed, including coordinating new state license applications, renewals, cross-licensure efforts, and maintaining accurate licensure records. • Monitor provider licenses, DEA and CDS registrations, board certifications, malpractice coverage, and other required credentials to ensure continuous compliance. • Provide exceptional support to providers throughout the enrollment, credentialing, and licensing process by communicating requirements, timelines, and next steps clearly and proactively.

View details: Licensing and Credentialing Specialist

Arizona + 11 more

$65K - $75K / year

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Credentialing Specialist

Sage Dental

See yourself at Sage.

Credentialing Specialist4 days ago

Full Time Remote SeniorTeam 1,001-5,000Since 1997H1B Sponsor

Company Site LinkedIn

• Adhere to NCQA guidelines. • Audit Provider Licensure Files to NCQA guidelines. • Pull Monthly Delegated Verification Files in accordance with NCQA. • Knowledge of Delegated Verification Websites (ie. National Provider Data Base, etc.). • Understanding of Initial and Re-Credential Delegated files / processing. • Prepare and Present provider files for internal and external auditing. • Upload and update the system and / or software with new documents. • Request & Obtain any Licensure renewals. • Must be able to utilize the licensure portals. • Experience in Clearinghouse / Manual Education Verifications. • Experience in Manual Hospital Privileges Verifications. • Experience in Board Certification Verifications through the appropriate portals. • Strong understanding of the differences between similar credentials (ie. Malpractice, Diplomas, etc.). • Knowledge of what a Credentialing Committee consists of. • Coordinate, monitor, maintain and process all internal re-credentialing to NCQA guidelines. • Heavy Understanding of Attestation questions, actions, exclusions and explanations. • Ability to speak effectively with providers, educators and internal departments. • Assist offices and internal departments with credentialing issues. • Ability to multi-task in a fast-paced environment. • Work other projects as assigned.

View details: Credentialing Specialist

United States

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Credentialing Specialist

Heartbeat Health

We're on a mission to deliver the most effective, efficient, and engaging heart care in the world.

Credentialing Specialist4 days ago

Full Time Remote SeniorTeam 11-50H1B Sponsor

Company Site LinkedIn

• 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.

View details: Credentialing Specialist

United States

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Credentialing Specialist

Sagility

S.O.A.R With Sagility

Credentialing Specialist12 days ago

Full Time Remote JuniorTeam 10,001+H1B Sponsor

Company Site LinkedIn

• Verify provider credentials through approved sources in a timely and accurate manner • Track and process credentialing and re-credentialing applications • Enter and update provider information in the credentialing database • Maintain and update provider demographics • Monitor and manage data from delegated entities • Communicate with providers or their office staff regarding credentialing status and required documentation • Identify and report non-compliance or credentialing issues to the supervisor • Ensure confidentiality of sensitive data and documents • Perform other duties as assigned

View details: Credentialing Specialist

United States

$20 / hour

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Credentialing Specialist

PRM

Our mission is to provide high-quality personal service to Arizona community association owners and Boards of Directors.

Credentialing Specialist14 days ago

Full Time Remote Mid LevelTeam 1-10Since 1997H1B No Sponsor

Company Site LinkedIn

• Reviews and processes applications for provider privileges • Focuses on follow-up, follow through and achievement of stringent deadlines • Reviews and analyzes provider credentialing file for completeness, accuracy, issues, and changes • Responds to provider inquiries received by letter, phone, or internal departments • Administers re-credentialing of Physicians and CRNAs • Complies with HIPAA regulations • Assists with other special projects and process redesign initiatives as requested

View details: Credentialing Specialist

Florida

$55K - $60K / year

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Facility Credentialing Specialist

Central Florida Inpatient Medicine

At Spectrum Medical Partners, you'll be part of a collaborative team dedicated to improving patient outcomes and delivering exceptional care. We value teamwork, accountability, innovation, and a culture where employees are supported and empowered to succeed. Apply today if you're a Florida-based Medical Assistant looking for a rewarding remote opportunity with a growing healthcare organization.

Credentialing Specialist16 days ago

Full Time Remote Mid Level

Role Description The Facility Credentialing Specialist is responsible for coordinating and managing the credentialing and privileging process for healthcare providers across skilled nursing facilities (SNFs), assisted living facilities (ALFs), long-term acute care hospitals (LTACHs), inpatient rehabilitation facilities (IRFs), and other post-acute healthcare facilities. This position serves as the primary liaison between providers, facility medical staff offices, and internal departments to ensure timely processing of facility applications and reappointments. Working in a remote environment, the Facility Credentialing Specialist maintains a high-volume portfolio of approximately 100-120 active facility privileging applications while utilizing credentialing software and established workflows to ensure accuracy, compliance, and timely completion. - Prepare, complete, and submit facility credentialing and privileging applications for physicians, advanced practice providers, psychologists, therapists, and other licensed healthcare professionals. - Manage a portfolio of up to 120 active facility applications and reappointments simultaneously while meeting established turnaround expectations. - Monitor application status and proactively follow up with facility medical staff offices to expedite processing. - Coordinate directly with providers to obtain required documentation, signatures, licensure updates, and other supporting information, in partnership with HR team/processes. - Maintain accurate files and electronic records within credentialing software. - Track expiration dates for licenses, certifications, DEA registrations, malpractice insurance, and other required documents. - Ensure all applications are complete, accurate, and submitted in accordance with individual facility requirements. - Communicate application status and outstanding items to providers and internal leadership weekly. - Respond promptly to facility requests for additional documentation or clarification. - Maintain confidentiality of provider information in accordance with HIPAA and organizational policies. - Assist with process improvement initiatives to increase efficiency and reduce credentialing turnaround times. - Support special credentialing projects and other administrative duties as assigned. Qualifications - High school diploma or equivalent required. - Minimum of one (1) year of healthcare administrative experience required. - Credentialing, medical staff services, provider enrollment, or healthcare operations experience preferred. - Experience working with MedTrainer software preferred but not required. - Extreme Tech proficiency overall, with strong skills in Microsoft Office Suite, including Outlook, Excel, Word, and Adobe Acrobat. - Strong computer skills and ability to learn new software systems quickly. Requirements - Pro-active & Positive attitude is a must! - Willingness to pick up the phone and contact people is key for this position. - Excellent organizational and time management skills. - Ability to manage multiple deadlines and competing priorities simultaneously. - Strong attention to detail with a high degree of accuracy. - Excellent written and verbal communication skills. - Ability to work independently in a remote environment while maintaining productivity and accountability. - Professional customer service skills when interacting with providers and facility personnel. - Strong problem-solving and critical-thinking abilities. - Ability to maintain confidential information with discretion. - Familiarity with post-acute healthcare environments is preferred. Work Environment - Fully remote position. - Standard business hours, Monday through Friday 8am-5pm. - Occasional extended hours may be required to meet business needs. - Primarily sedentary work (at a desk/in front of a computer), requiring prolonged computer use. Performance Expectations - Timely completion of facility credentialing applications. - Accuracy and completeness of submitted applications. - Credentialing turnaround times. - Provider and facility satisfaction. - Maintenance of current provider credential files. - Compliance with organizational policies and regulatory requirements. - Effective management of an assigned portfolio of up to 120 concurrent facility applications. Preferred Experience - Candidates with experience supporting multi-specialty provider groups serving skilled nursing facilities, assisted living communities, rehabilitation hospitals, or other post-acute care settings are strongly preferred. - This can also be an entry-level position for the right person! Salary Range $40,000–$50,000 annually, commensurate with experience and qualifications.

View details: Facility Credentialing Specialist

United States

$40K - $50K / year

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Job Closed

Credentialing Specialist

Oscar

Award-winning recruitment consultancy; delivering talent across Tech, Digital, Life-Sciences, Energy & Construction

Credentialing Specialist17 days ago

Full Time Remote JuniorTeam 51-200H1B Sponsor

Company Site LinkedIn

• Develop a comprehensive understanding of the current processes, procedures, and tools associated with credentialing. • Interact daily with providers or internal Oscar teams according to assignment needs • Manage an assigned caseload while maintaining service delivery, productivity, and quality expectations • Form working relationships with internal and external stakeholders. • Support the leadership team by identifying issues through established escalation pathways • Be accountable for monitoring and tracking the health of all assigned work-in-progress issues. • Escalate and resolve issues to ensure appropriate turnaround times • Be an active participant in process improvement initiatives • Comply with all operational, regulatory, and compliance standards relating to member Personal Health Information (PHI) • Compliance with all applicable laws and regulations • Other duties as assigned

View details: Credentialing Specialist

Arizona + 2 more

$19 / hour

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Job Closed

Specialist II, Credentialing

Nightingale Education Group

Supporting group for Nightingale College, Nightingale Innovations, and Nightingale Solutions.

Credentialing Specialist17 days ago

Full Time Remote SeniorTeam 11-50H1B No Sponsor

Company Site LinkedIn

• The Specialist II, Credentialing helps guide advanced placement newly entering their experiential learning course learners through their final credentialing needs to help support learners in the successful completion of the Experiential Learning (EL)program. • The incumbent will provide guidance on navigating credentialing systems, and be a key point of contact regarding credentialing needs for Direct Focused Care (DFC). • Provides exceptional customer service to a larger group learners while helping to navigate the College Catalog, credentialing systems, requirements from the Center of Disease Control (CDC), purchase and completion of background checks and drug screens, and build transparency and understanding of expectations during the completion of the program. • Collaborates cross-functionally to facilitate the onboarding of credentialing for new admission to the College. • Guides learners in creating their profile within the credentialing portals. • Contacts learners to assist in maintaining and restoring credentialing compliance. • Reviews compliance in multiple systems to complete audits and determine appropriate contact and action. • Participates in additional training and compliance activities to promote additional learning and understanding of credentialing processes and policies. • Provides guidance to fellow collaborators and learners on policies, procedures, and the requirements for experiential learning courses to attend their on-ground experience. • Participates in the successful implementation of other functional projects as they arise.

View details: Specialist II, Credentialing

United States

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Credentialing Specialist

Assembly Health

Assembly™ Health delivers revenue cycle management and back-office solutions to support quality care.

Credentialing Specialist18 days ago

Full Time Remote SeniorTeam 201-500H1B No Sponsor

Company Site LinkedIn

• Complete enrollment/credentialing and re-credentialing applications • Maintain a detailed log of all pending and completed work • Communicate the results and status of the applications to physicians, payers, managers, and co-workers. • Maintenance of physician enrollment and CAQH profiles • Documentation within enrollment database • Coordinate signatures • Payer processing and research • Involves extensive phone work and internet. • Research and resolve claim issues related to physician enrollment. • Other tasks as needed.

View details: Credentialing Specialist

United States

$19 - $23 / hour

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