Licensing and Credentialing Specialist
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Job Description
Licensing specialist managing provider payer enrollment, credentialing, and state licensing. Supporting Oshi Health’s virtual digestive care practice and timely patient access.
Responsibilities:
- Own the end-to-end payer enrollment process for new and existing providers, including initial enrollments, revalidations, demographic updates, terminations, and maintenance across commercial, Medicare, and Medicaid health plans
- Submit, track, and proactively follow up on payer enrollment applications
- Serve as the primary point of contact with health plans, delegated credentialing organizations, CVOs, and internal stakeholders to resolve enrollment issues and escalations
- Maintain accurate provider data across payer portals, CAQH, credentialing systems, and internal tracking tools
- Support delegated credentialing activities, provider rosters, compliance monitoring, and audit documentation
- Conduct routine audits of provider enrollment and credentialing files for NCQA, CMS, state, and payer-specific compliance
- Monitor enrollment and credentialing metrics, identify risks, and communicate status updates to leadership and cross-functional partners
- Collaborate with Licensing, Practice Operations, Revenue Cycle, Recruiting, and Clinical Operations teams
- Improve enrollment and credentialing workflows through standardization, documentation, automation, and operational efficiencies
- Support new state license applications, renewals, cross-licensure efforts, and licensure record maintenance
- Monitor provider licenses, DEA and CDS registrations, board certifications, malpractice coverage, and other required credentials
- Support providers throughout enrollment, credentialing, and licensing by communicating requirements, timelines, and next steps
Requirements:
- Bachelor’s Degree in Healthcare administration or related field
- 3+ years of experience in provider payer enrollment and credentialing
- Experience managing provider enrollments with commercial, Medicare, and Medicaid payers
- Experience supporting delegated credentialing activities, including provider rosters, ongoing monitoring, or audit preparation
- Experience with multi-state or national provider organizations
- Working knowledge of CAQH, payer portals, and provider credentialing systems
- Understanding of NCQA, CMS, state licensing, and payer credentialing requirements
- Strong organizational skills with the ability to manage multiple priorities and deadlines
- Excellent attention to detail and written and verbal communication skills
- Proficiency with Google Workspace, including Google Sheets
- CPCS certification or equivalent credential preferred
- 1+ year working in Verifiable Enrollment and Licensing Manager
- Experience supporting delegated credentialing audits and corrective action plans
- Familiarity with provider licensing and cross-state licensure
- Experience working with credentialing vendors (CVOs)
- Experience in a virtual care or telehealth environment
- Experience working in a fast-paced, high-growth startup environment
- Process improvement mindset with experience documenting or streamlining workflows
- Must currently reside and plan on residing throughout employment in one of: Arizona, Delaware, Florida, Georgia, Idaho, Indiana, Louisiana, Michigan, Missouri, New Hampshire, New Jersey, North Carolina, Rhode Island, Pennsylvania, South Carolina, Tennessee, Texas, Vermont, Virginia, or Wisconsin
- Monday-Friday, 9-6pm EST schedule
Benefits:
- Salary Range: 65,000-75,000 per year plus bonus eligibility
- Employer-sponsored medical, dental, and vision coverage
- Flexible Time Off + 11 paid company holidays + 1 floating holiday
- Eligibility to contribute to 401(k)
- Remote-first — work from home within approved states
- Tailored professional development opportunities as we scale
- Access to Overalls, because we know life happens
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