Insurance Credentialing Specialist
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Job Description
Remote credentialing specialist managing U.S. healthcare provider credentialing and payer enrollment. Maintaining CAQH, PECOS, Medicaid, commercial payer applications, records, and deadlines.
Responsibilities:
- Manage the full credentialing lifecycle, including initial payer enrollment, contracting, recredentialing, revalidation, and ongoing payer participation across multiple payers and states
- Prepare, submit, and track applications from initial submission through approval and confirmed effective date
- Build and maintain CAQH ProView profiles, including initial setup, attestations, and reattestations
- Ensure provider information is accurate and consistent across CAQH, payer portals, and internal records
- Maintain complete and current provider files, including NPI Type 1 and Type 2, taxonomy codes, state licenses, DEA registrations, board certifications, malpractice insurance, and provider demographics and practice information
- Submit and manage Medicare enrollment through PECOS
- Complete enrollment with state Medicaid programs and managed-care plans, as well as commercial and behavioral health payers
- Monitor pending, incomplete, returned, and rejected applications and follow up proactively through payer portals and provider-enrollment phone lines
- Resolve enrollment issues and follow applications through to an approved effective date
- Maintain a centralized credentialing tracker and provide weekly status reports
- Monitor upcoming recredentialing, revalidation, license, certification, and other expiration deadlines to prevent lapses
- Escalate payer delays or issues when necessary
- Coordinate with billing to confirm payer enrollment and effective dates so claims are not submitted before a provider is properly active
- Maintain accurate, organized, and audit-ready credentialing documentation
Requirements:
- Hands-on experience with CAQH ProView
- Hands-on experience with NPPES / NPI Registry
- Hands-on experience with PECOS for Medicare enrollment
- Hands-on experience with state Medicaid provider portals
- Hands-on experience with commercial payer portals, including Availity and payer-specific systems
- Experience with provider credentialing and payer enrollment processes
- Knowledge of taxonomy codes and provider enrollment documentation
- Knowledge of payer-specific enrollment and credentialing requirements
- Proven experience in provider credentialing and payer enrollment
- Strong understanding of Medicare, Medicaid, commercial, and behavioral health payer enrollment
- Excellent attention to detail and documentation management
- Strong follow-up skills and persistence when working with payers
- Ability to manage multiple providers, payers, states, and deadlines simultaneously
- Strong organizational and time-management skills
- Ability to identify missing or inconsistent information before it causes enrollment delays
- Comfortable communicating with payer representatives and provider enrollment departments
- Self-directed and able to manage the credentialing process with minimal supervision
Benefits:
- Competitive hourly rate
- On-time payments, every time
- Payments processed via Wise
- Direct client training provided
- Dedicated Account Manager as your point of contact
- Stable, long-term placement with a growing U.S.-based company
- Exposure to a wide range of modern SaaS platforms
- Potential for increased responsibilities as the company scales
- Tenure recognition for long-term team members
- Clear escalation paths
- 100% remote — work from home
- Supportive team culture across all accounts
- Potential for increased hours or additional accounts based on performance
- Build your U.S. industry experience
- Exposure to multiple practice types and platforms
- Strengthen your resume with verified, legitimate U.S. client experience
- Recognition for loyalty and long-term growth
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