Licensing & Credentialing Specialist
Posted 8ds ago
Employment Information
Report this job
Job expired or something wrong with this job?
Job Description
Licensing & Credentialing Specialist responsible for managing provider credentialing at CareTalk Health. Ensuring compliance with CMS, NCQA, and state regulatory requirements for telehealth.
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)
- 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
- 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
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
Benefits:
- 100% Remote
Similar Jobs
3d
Credentialing Specialist
Credentialing Specialist processing physician applications and maintaining medical staff databases for HonorHealth, an Arizona nonprofit healthcare system. Ensuring compliance with healthcare credentialing standards.
3d
4d
Credentialing Specialist – Coordinator
Remote part-time credentialing specialist maintaining provider credentials and payer enrollment for a Massachusetts health center. Managing CAQH, PECOS, MassHealth, Medicare, Medicaid, and commercial payer documentation.
4d
No more related jobs available.