Credentialing Specialist
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Job Description
Credentialing Specialist managing multi-state provider enrollment and compliance for Holon Health, a whole-person healthcare startup serving justice-involved individuals with SUD.
Responsibilities:
- Coordinate initial credentialing, recredentialing, and payer enrollment for physicians, advanced practice providers, and other licensed clinicians
- Manage Medicare, Medicaid, and commercial payer enrollment applications across multiple states
- Perform primary source verifications and revalidations
- Submit and manage provider demographic updates, location additions, participation requests, and other enrollment changes
- Monitor applications through completion and follow up with payers to resolve delays or discrepancies
- Maintain provider credentialing files, databases, and reporting systems
- Monitor and update CAQH, PECOS, NPPES, Availity, and state enrollment systems
- Track and manage expirations for licenses, DEA registrations, malpractice insurance, board certifications, attestations, and other credentials
- Maintain compliance with Holon Health policies, NCQA standards, CMS requirements, and state and federal regulations
- Prepare documentation for audits, accreditation reviews, and payer credentialing requests
- Support provider onboarding and new market expansion
- Maintain provider rosters and coordinate submissions to participating health plans
- Respond to credentialing inquiries from providers, health plans, regulatory agencies, and internal stakeholders
- Manage credentialing inboxes and daily workflows, including approvals, denials, appeals, and payer correspondence
- Partner with Operations, Leadership, Contracting, and Compliance teams
- Identify process improvements to increase efficiency, accuracy, and turnaround times
Requirements:
- At least five (5) years of experience in healthcare credentialing, provider enrollment, medical staff services, or a related area
- Bachelor’s degree in Healthcare Administration, Business Administration, or a related field preferred
- Equivalent experience will be considered
- Strong knowledge of credentialing and recredentialing, payer enrollment workflows, and primary source verification
- Experience with Medicare, Medicaid, and commercial health plans
- Experience managing credentialing and enrollment across multiple states
- Proficiency with credentialing systems, provider portals, and Microsoft Office
- Strong organizational skills, attention to detail, and follow-through
- Ownership and accountability for accurate, audit-ready work
- Ability to manage multiple priorities and meet deadlines in a dynamic environment
- Clear written and verbal communication with providers, payers, and internal teams
- Experience with Modio or another credentialing database nice to have
- Experience with telehealth or integrated healthcare models nice to have
- Experience developing and implementing delegated credentialing processes nice to have
Benefits:
- Unlimited PTO
- Flexible schedules
- Remote-first culture
- Health insurance
- Dental insurance
- Vision insurance
- Life insurance
- Disability insurance
- 401(k) with company match
- Space for self-care
- Room to grow in a high-impact, mission-driven startup
- Team that celebrates wins, learns from losses, and provides support
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