Credentialing Specialist

Job Description

Job Description

Description:

Be Part of Something Radically Different

At Holon Health, we don’t do “business as usual.” We’re a trailblazing healthcare startup reimagining what it means to care, for our clients and our people. We provide whole-person care to justice-involved individuals living with Substance Use Disorder (SUD), and we do it with deep compassion, community wisdom, and an unshakable belief in second chances.

Our approach throws out the playbook. We integrate medical, behavioral, and social care. We prioritize prevention and recovery. We treat clients like people, not checkboxes. And just as importantly, we know that our team can only care for others if they’re cared for themselves. That’s why we lead with flexibility, trust, and a culture built on well-being, inclusion, and respect.

If you’re energized by meaningful work and want to feel good about how you spend your days, read on.

About the Role

Holon Health is seeking a Credentialing Specialist to support and safeguard the work that lets our providers deliver care. This role owns provider onboarding, credentialing, recredentialing, licensure management, and payer enrollment across multiple states, keeping our clinicians enrolled and maintained with commercial, Medicare, and Medicaid payers while staying compliant with regulatory, accreditation, and organizational requirements.

This is a role for someone who is organized, resourceful, and comfortable managing many moving pieces at once. You will work closely with providers, health plans, regulatory agencies, and internal teams to keep credentialing and enrollment accurate and on time, and you will help build the processes that keep it that way as we grow into new markets.

What You’ll Do

Credentialing and Enrollment

• 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 in line with payer, regulatory, and accreditation requirements.

• Submit and manage provider demographic updates, location additions, participation requests, and other enrollment changes.

• Monitor applications through completion and follow up proactively with payers to resolve delays or discrepancies.

Provider Data Management and Compliance

• Maintain the accuracy and integrity of provider credentialing files, databases, and reporting systems.

• Monitor and update external credentialing databases and portals, including CAQH, PECOS, NPPES, Availity, and state enrollment systems.

• Track and manage expirations for licenses, DEA registrations, malpractice insurance, board certifications, attestations, and other time-sensitive credentials.

• Keep provider records compliant with Holon Health policies, NCQA standards, CMS requirements, and state and federal regulations.

• Prepare and maintain documentation for audits, accreditation reviews, and payer credentialing requests.

Operational Support and Collaboration

• Support provider onboarding and new market expansion efforts.

• 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 to support shared goals.

• Identify process improvements that increase efficiency, accuracy, and turnaround times.

Requirements:

What You’ll Bring

• 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, and with managing credentialing and enrollment across multiple states.

• Proficiency with credentialing systems, provider portals, and Microsoft Office.

• Excellent organizational skills, with strong attention to detail and follow-through.

• A dependable sense of 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 the ability to work professionally with providers, payers, and internal teams.

Nice to Have

• Experience with Modio or another credentialing database.

• Experience with telehealth or integrated healthcare models.

• Experience developing and implementing delegated credentialing processes.

What Success Looks Like

• Credentialing and enrollment applications are completed accurately and submitted on time.

• Provider records stay current, compliant, and audit-ready.

• Enrollment delays are identified and resolved proactively.

• Expiring credentials are tracked and renewed before deadlines.

• Credentialing processes keep improving in accuracy, efficiency, and turnaround time.

The Holon Way

We’re not just building a better model of care, we’re building a better workplace. That means:

• Base salary of $60–$65k

• Unlimited PTO (we mean it)

• Flexible schedules that work with your life

• Remote-first culture with connection baked in

• Full suite of benefits, including health, dental, vision, life, and disability

• 401(k) with company match

• Space for self-care, because you can’t pour from an empty cup

• Room to grow in a high-impact, mission-driven startup

• A team that celebrates wins, learns from losses, and has your back

Our Commitment to DE&I

Diversity, equity, and inclusion aren’t buzzwords here, they’re the foundation. We embrace the full spectrum of human experience and are proud to be an equal opportunity employer. If you’re passionate about our mission but don’t meet every qualification, we still encourage you to apply.

Ready to do work that matters, on a team that sees you?

Apply now. Let’s build something extraordinary together.