Credentialing Specialist

Clarity RCM

25d•Remote

About The Position

Clarity RCM is the nation’s leading revenue cycle platform for dermatology, partnering with independent practices in over 40 states to improve financial performance, streamline operations, and deliver exceptional patient experiences. We are a profitable, fast-growing company with a fully remote U.S. team and a large in-office operation in India. We are seeking a highly organized, detail-oriented, and execution-focused Credentialing Specialist who will own provider enrollment, credentialing workflows, and payer setup for dermatology practices nationwide. This is a critical role that requires someone who can make sense of complex, disparate information and turn it into clear, repeatable processes. The ideal candidate thrives in environments that need more structure. You enjoy bringing order to moving parts, synthesizing information from many sources, and building systems where none exist. You take pride in creating workflows, organizing information, documenting steps, and establishing processes that allow the credentialing function to scale. You should be comfortable with complex requirements, persistent follow-up, and maintaining accurate, audit-ready documentation at all times. You are tech savvy, proactive, and committed to delivering clean, reliable work that enables providers to practice without interruption.

Requirements

Experience: 2 to 3 years of hands-on medical credentialing or payer enrollment experience.
Technical Knowledge: Familiarity with CAQH, PECOS, payer portals, and credentialing software. Strong understanding of NCQA, TJC, CMS, and standard credentialing requirements.
Structure Building: A track record of bringing order to complex or unstructured environments and building processes that scale.
Attention to Detail: Ability to identify inconsistencies instantly and maintain clean, accurate files.
Follow-Through: Persistent and professional when gathering documentation or resolving gaps.
Communication: Clear, concise, and confident written and verbal communication skills.
Technology Mindset: Comfortable navigating multiple systems and adopting new tools.
Judgment: Ability to handle PHI and sensitive information with complete discretion.
Mindset: Process-driven, organized, proactive, resourceful, and committed to continuous improvement.

Responsibilities

Own the full lifecycle of credentialing for physicians and advanced practice providers, including initial onboarding, primary source verification, re-credentialing, and ongoing monitoring.
Verify education, training, licenses, board certifications, malpractice insurance, and work history with complete accuracy.
Ensure all credentialing files meet NCQA, TJC, CMS, and payer-specific requirements.
Prepare, submit, and track enrollment applications with commercial payers including BCBS, UHC, Aetna, and Cigna, as well as Medicare and Medicaid.
Manage CAQH ProView including quarterly attestations and document maintenance.
Process Medicare enrollments and updates through PECOS.
Verify that providers are correctly linked to group tax IDs to prevent out-of-network billing issues.
Track effective dates and panel statuses and communicate updates to internal stakeholders.
Create structure in areas that currently have few or inconsistent processes.
Organize credentialing inputs from multiple sources and turn them into clear workflows, trackers, and checklists.
Identify bottlenecks, design solutions, and implement improvements that enhance accuracy, speed, and consistency.
Document processes and maintain updated SOPs that support ongoing team alignment and scale.
Work closely with internal teams to keep credentialing and enrollment workflows moving.
Support account managers, operations, and revenue cycle teams by providing accurate status updates and resolving credentialing-related blockers.
Partner with billing and AR teams to investigate and resolve claim denials caused by credentialing or enrollment issues.
Maintain accurate provider data across CAQH, PECOS, payer portals, and internal systems.
Own a master tracker that includes effective dates, expirables, re-credentialing deadlines, panel statuses, and outstanding items.
Keep all credentialing records continuously audit-ready with complete and up-to-date documentation.
Monitor expiring state licenses, DEA registrations, malpractice insurance, and board certifications.
Communicate proactively with providers to ensure renewals are completed well before expiration dates.