Credentialing & Enrollment Specialist II

Brightside Health

90d•Remote

About The Position

Brightside Health is seeking an experienced Credentialing & Enrollment Specialist II to support its growing national provider network. Reporting to the Manager, Credentialing and Enrollment, this role manages credentialing and enrollment production work with minimal supervision, including complex cases across the provider lifecycle. The specialist also serves as a resource for Credentialing Specialist I team members and may take on limited subject matter expert responsibilities. The position covers provider onboarding, credentialing and re-credentialing, primary source verification, payer enrollment and roster management, provider communications, revenue protection support, compliance activities, and credentialing systems and data maintenance. The role is part of a fully remote, mission-driven team that collaborates across engineering, product, and clinical functions.

Requirements

At least 3 years of experience in credentialing and/or enrollment operations.
Experience with group-level Medicaid enrollment.
Working knowledge of NCQA standards, CAQH, and payer enrollment processes.
Proficiency with payer portals, including CAQH, PECOS, Availity, and payer-specific portals.
Strong attention to detail and documentation habits.
Ability to manage multiple priorities and consistently meet deadlines.

Nice To Haves

Experience with both commercial and government payer enrollment.

Responsibilities

Execute provider onboarding readiness tasks and check intake packet completeness.
Prepare and submit initial credentialing and re-credentialing applications.
Submit and monitor primary source verifications through CVO and perform PSV according to departmental policies and NCQA standards when it is 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 provider expirables and renewal timelines.
Complete and submit group and individual enrollment applications to commercial and government payers, and follow up through completion.
Execute roster additions, updates, and terminations as directed by the Senior IC, and correct roster discrepancies.
Maintain payer contact lists and portal access; track enrollment statuses and update Salesforce.
Maintain CAQH and PECOS profiles and follow up on payer issue tickets and cases.
Handle provider onboarding communications, status requests, and documentation guidance; manage provider issue intake and routing; follow up on missing items.
Support enrollment-related claim denial triage, provider billing activation coordination, and resolution of roster-related billing issues.
Gather audit evidence as directed by the Senior IC, prepare delegated credentialing files, and perform credentialing file quality assurance.
Collect and verify provider malpractice policies and insurance documents, track expiration dates, and follow up on renewals.
Keep provider demographic data current across credentialing systems, CAQH, and payer records.
Maintain credentialing platform records, internal trackers, and payer portal accounts.
Serve as a resource for Credentialing Specialist I team members and may provide limited subject matter expertise to support team operations.