Credentialing & Enrollment Specialist II
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Job Description
Credentialing and Enrollment Specialist II managing provider credentialing, payer enrollment, rosters, and compliance. Supporting Brightside Health’s virtual mental healthcare provider network.
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
- Serve as a resource for Credentialing Specialist I team members
- Support team operations through limited subject matter expert responsibilities
- Report directly to the Manager, Credentialing and Enrollment
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
Benefits:
- A competitive salary
- Fully paid for comprehensive health care (medical, dental, vision)
- Pet Insurance
- Life Insurance & Short / Long Term Disability
- 401k Plan
- Unlimited PTO and sick leave
- Parental Leave
- Work remotely and whatever schedule works best for you
- Additional memberships and perks
- Continuous learning opportunities
- Flexible work environment
- Cross-functional collaboration
- Equal employment opportunities based on merit, competence, and performance
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