Credentialing Specialist

CIVIE

2d • $45,000 - $55,000 • Remote

About The Position

The Credentialing Specialist coordinates and executes credentialing and re-credentialing for healthcare providers, ensuring they meet regulatory, accreditation, and payer requirements while keeping credentialing records accurate and up to date. The role works collaboratively with health plans, payers, and providers to support timely onboarding and enrollment. This is a fully remote position, and candidates must reside within the United States.

Requirements

• High school diploma or equivalent.
• At least 2 years of relevant credentialing experience.
• Working experience in CAQH, PECOS, Availity, and Verity.
• Willingness to learn and build a process for onboarding new clients for payer claim enrollment and EFT enrollments.
• Self-driven and motivated, with great attention to detail.
• Ability to manage multiple priorities and meet deadlines.
• Comfort with multitasking and working in a tech-driven environment.
• Organized and focused while navigating multiple systems.
• Ability to handle sensitive and confidential information with discretion.

Nice To Haves

• Certified Provider Credentialing Specialist (CPCS) certification.

Responsibilities

• Manage the full credentialing and re-credentialing process for assigned providers.
• Conduct primary source verification of licenses, board certifications, education, training, and work history.
• Submit and track credentialing applications to health plans, payers, and provider networks.
• Maintain accurate provider records in credentialing databases and electronic systems.
• Monitor expiration dates for licenses, DEA registrations, malpractice insurance, and certifications to prevent lapses.
• Ensure compliance with state, federal, and accreditation standards.
• Review provider applications for completeness and accuracy, and follow up on missing or incomplete documentation.
• Respond to payer inquiries and assist in resolving credentialing discrepancies or denials.
• Communicate credentialing status updates to providers and internal stakeholders.
• Identify opportunities to improve the efficiency, accuracy, and timeliness of credentialing processes.

Benefits

• Paid vacation, sick time, and personal days.
• 11 company-paid holidays.
• Health, dental, and vision benefits, with employer HSA contribution.
• 401(k) company match and profit sharing.
• Short-term disability, long-term disability, and life insurance.
• Quarterly UberEats voucher.
• Monthly Fringe benefits.
• Professional development stipend.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED