Credentialing Specialist

Credentialing Specialist

Heartbeat Health is the leading virtual-first cardiovascular care company in the country, providing patients with convenient, high-quality heart care through a combination of telemedicine, diagnostics, and virtual care programs. By leveraging real-time data and AI-powered insights, Heartbeat Health empowers providers and patients with personalized treatment plans, reducing hospitalizations and improving long-term heart health outcomes. Heartbeat Health is redefining how cardiovascular care is delivered in the digital age, led by our medical group of cardiologists, advanced practitioners, nurses, and care coordinators.

We are a nationwide telehealth organization seeking a Credentialing Specialist to support our growing provider network.

About the Role:

This role is responsible for end-to-end provider credentialing and payer enrollment across government and commercial payers, ensuring providers are set up for success in a multi-state, virtual care environment. The Credentialing Specialist will work closely with providers, payers, and revenue cycle teams to streamline enrollment, maintain compliance, and support timely reimbursement.

Responsibilities:

• Complete and manage all aspects of initial credentialing, re-credentialing, and payer enrollment for a large network of telehealth providers across the U.S.
• Submit and track applications with government payers (Medicare, Medicaid, VA, Tricare) and commercial/private payers to ensure active participation status.
• Lead and mentor credentialing staff, providing training, guidance, and quality checks.
• Serve as the subject matter expert (SME) for credentialing, payer enrollment, and their connection to revenue cycle processes
• Optimize credentialing turnaround time and reduce payer enrollment delays that impact revenue
• Stay up to date on payer regulations and credentialing requirements across all states where the organization provides telehealth services
• Analyze denial trends related to credentialing/enrollment issues and implement corrective actions
• Track payer roster accuracy and manage data integrity between credentialing systems and billing systems.
• Maintain accurate provider records in credentialing systems (e.g., CAQH, payer portals, internal databases), ensuring information is current and compliant.
• Verify provider credentials including education, training, board certification, work history, malpractice history, and references.
• Ensure provider enrollment aligns with billing requirements, reducing claim denials and reimbursement delays for a streamlined Revenue Cycle Management (RCM) process
• Monitor payer rosters and enrollment timelines to proactively resolve issues that may impact revenue.
• Support the onboarding of new providers by ensuring credentialing and enrollment are completed prior to patient scheduling.
• Prepare reports on credentialing status, payer enrollment progress, and upcoming expirations for leadership and compliance purposes.
• Assist with audits, quality checks, and process improvements to ensure compliance

About You:

• You're open to new ideas, thoughtful in your approach, pragmatic in your delivery, constantly learning, and up for a challenge. You elevate the work of those around you. You want the superpower to save millions of lives. You possess the following qualifications:

Education:

• High school diploma or equivalent required; Associate's or Bachelor's degree in Healthcare Administration or related field preferred.

Experience:

• 5-7 years of experience in healthcare credentialing and payer enrollment (telehealth or multi-state experience strongly preferred).

Skills:

• Strong knowledge of government and commercial payer enrollment requirements
• Familiarity with RCM processes and how credentialing impacts reimbursement
• Proficiency with credentialing platforms and payer portals (e.g., CAQH)
• Excellent organizational skills with the ability to manage multiple providers and payers across states
• Strong communication skills to build positive relationships with providers, payers, and internal teams

Traits:

• High attention to detail, accuracy, and ability to meet strict deadlines

About Our Culture:

We are mission-driven: we're revolutionizing the way cardiovascular care is delivered

We are fast-paced & agile: we move quickly, iterate often, and value experimentation

We are remote-first: flexibility, autonomy, and trust are at the core of how we operate

We care about diversity: diversity allows us to build an excellent patient experience

We are an equal opportunity employer: we do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status