Licensing & Credentialing Specialist (Remote, W2)

CareTalk Health

2d•Remote

About The Position

The Licensing & Credentialing Specialist is responsible for managing end-to-end provider credentialing, licensing, and payer enrollment processes across a nationwide, 50-state virtual care model. This role ensures all providers and nursing staff meet regulatory, accreditation, and payer requirements while maintaining accurate, compliant records across multiple systems. This individual will also serve as a key resource for state-specific regulatory requirements, including nurse licensure tracking and Nurse Practitioner (NP) collaborative agreement requirements, ensuring CareTalk Health remains compliant across all jurisdictions.

Requirements

3+ years of experience in healthcare credentialing, licensing, and payer enrollment
Strong knowledge of CMS regulations, Medicare enrollment processes, and multi-state licensing requirements
Hands-on experience with CAQH, PECOS, NPPES, and payer portals
Experience managing 855i applications and Medicare provider enrollment workflows
Demonstrated experience tracking multi-state licensure and expirations for providers and nursing staff (RNs, LVNs, LPNs)
Experience researching and applying state-specific regulatory requirements, including NP collaborative agreements
Knowledge of credentialing standards including NCQA
Strong database management experience within credentialing systems
Exceptional organizational skills with strong attention to detail
Windows or Apple (macOS) Computer ONLY (NO Chromebooks, Linux Machines, or Smartphones)
Must have at least Windows 10 or macOS 14 Sonoma.
Processor: Intel Core i5 or AMD Equivalent (Windows); Apple Silicon (Macs)
RAM: 16 GB
Wired headphones required for optimal audio quality. (NO built-in mics)
Meet minimum internet speed requirements (100 MBPS download speed and 50 MBPS upload speed). Must have an ethernet cable connecting computer directly into router.
Use Google Chrome with Amazon Workspaces (regardless of computer type).
A webcam is required for video calls. Most laptops have a built-in webcam, which is acceptable. If your computer does not have a webcam, you will need to use an external webcam.

Nice To Haves

Certification from National Association Medical Staff Services (NAMSS): Certified Provider Credentialing Specialist (CPCS) or Certified Professional Medical Services Management (CPMSM)
A second monitor is highly suggested for laptop users; dual monitors for PC users.

Responsibilities

Manage full-cycle provider credentialing and recredentialing processes in compliance with CMS, NCQA, and state regulatory requirements
Oversee medical payer enrollment activities, ensuring timely and accurate submission of applications to commercial payers and government entities (e.g., Medicare)
Complete and manage PECOS and CMS 855i enrollments and updates
Partner with providers to maintain and update CAQH profiles to ensure accuracy and attestation compliance
Maintain and track provider records in credentialing databases, ensuring data integrity, accuracy, and confidentiality
Track and manage active licenses and expiration dates via Modio for Physicians and Advanced Practice Providers, Registered Nurses (RNs), Licensed Vocational Nurses (LVNs), and Licensed Practical Nurses (LPNs)
Proactively monitor expirations and coordinate renewals via Modio to ensure uninterrupted compliance and ability to practice
Maintain working knowledge of all 50-state licensure and practice requirements impacting telehealth delivery
Research and interpret state-specific regulations, including Nurse Practitioner collaborative/supervisory agreement requirements and scope of practice variations by state
Establish and maintain processes to ensure compliance with varying state laws and regulatory updates
Coordinate and manage collaborative agreements in accordance with state-specific requirements
Monitor credentialing status and proactively resolve issues or delays with payers and regulatory agencies
Conduct thorough review of credentialing applications in alignment with NCQA and accreditation standards
Maintain provider data across platforms including CAQH, NPPES, PECOS, and payer portals
Maintain comprehensive databases of provider information, ensuring accuracy and confidentiality
Handle sensitive information with strict adherence to HIPAA and healthcare privacy standards
Collaborate cross-functionally with recruiting, operations, and compliance teams to ensure timely onboarding