Credentialing & Enrollment Specialist II

Brightside Health

2d•Remote

About The Position

We are currently seeking a Credentialing & Enrollment Specialist II to join our credentialing team as we continue to grow and provide patient services on a national scale. This role will report directly to our Manager, Credentialing and Enrollment and will serve as an experienced cross-functional operator within the team. In this role, you will manage the full range of credentialing and enrollment production work with minimal supervision, including more complex cases across the provider lifecycle. You will also serve as a resource for Credentialing Specialist I team members and may take on limited subject matter expert responsibilities to support team operations. This position represents the experienced production role within the unified credentialing and enrollment team and plays an important part in ensuring the continued growth and quality of our national provider network.

Requirements

3+ years of experience in credentialing and/or enrollment operations
Working knowledge of NCQA standards, CAQH, and payer enrollment processes
Experience with both commercial and government payer enrollment preferred
Proficiency with payer portals (CAQH, PECOS, Availity, payer-specific)
Strong attention to detail and documentation habits
Ability to manage multiple priorities and meet deadlines consistently

Responsibilities

Execute provider onboarding readiness tasks and intake packet completeness checks
Prepare and submit initial credentialing and re-credentialing applications
Submit and monitor primary source verifications through CVO
Perform PSV according to departmental policies and NCQA standards when not completed by CVO
Review CVO-processed files for completeness and accuracy
Process provider status changes, terminations, and reactivations
Collect and follow up on missing provider documentation
Track and manage provider expirables and renewal timelines
Complete and submit group and individual enrollment applications to commercial and government payers
Follow up on submitted enrollment applications through completion
Execute roster additions, updates, and terminations as directed by Senior IC
Correct roster discrepancies
Maintain payer contact lists and portal access
Track enrollment statuses and update Salesforce accordingly
Manage CAQH and PECOS profile maintenance
Follow up on payer issue tickets and cases
Handle provider onboarding communications, status update requests, and documentation guidance
Manage provider issue intake and routing
Follow up with providers on missing items
Support enrollment-related claim denial triage
Assist with provider billing activation coordination
Help resolve roster-related billing issues
Gather audit evidence as directed by Senior IC
Prepare delegated credentialing files
Perform credentialing file QA
Collect and verify provider malpractice policies and insurance documents
Track insurance expiration dates and follow up on renewals
Ensure provider demographic data is current across credentialing systems, CAQH, and payer records
Maintain credentialing platform records and internal trackers
Maintain payer portal accounts