Credentialing and Enrollments Specialist

Job Description

Job Description

About Us

Modena Health ("MH") and Modena Allergy & Asthma ("MAA") are leading and rapidly growing medical practices specializing in allergy, asthma, and immunology care, with clinics across Southern California and Arizona—and ambitious plans for national expansion. We are physician-led, hospitality-focused, and technology-enabled, committed to transforming allergy care while advancing clinical research and expanding access to cutting-edge medicine.

Known for our high standard of excellence, we provide compassionate, patient-centered care for both pediatric and adult patients. Our model combines hospitality-driven service with innovative technology solutions that streamline operations, improve clinical outcomes, and enhance the experience for both patients and providers.

At Modena, we aim to hire great people, treat them well, and help them find meaning and purpose in our mission. Our dedicated team values collaboration, positivity, and growth while striving to improve lives through expert diagnosis, treatment, and research. We are looking for high-energy, kind, and collaborative individuals eager to grow personally and professionally while making a meaningful impact in the lives of others.

Position Summary

The Credentialing & Enrollments Specialist is responsible for managing the credentialing, payer enrollment, and provider onboarding processes for the practice's physicians and advanced practice providers. This role ensures providers are credentialed, enrolled, and maintained with commercial and government payers in a timely and accurate manner to support uninterrupted billing and patient care operations.

The specialist maintains provider records, monitors credentialing deadlines, coordinates with payers and providers, and serves as a key resource for credentialing and insurance operations. This position requires strong organizational skills, attention to detail, and the ability to manage multiple deadlines in a fast-paced healthcare environment.

This role is non-exempt (hourly) and full-time, 40 hours per week, Monday through Friday. The position is remote, with preference for candidates residing in California, Arizona, Colorado, New Mexico, or South Carolina. Occasional overtime may be required to meet credentialing deadlines or business needs.

Essential Duties & Responsibilities

Credentialing & Payer Enrollments

• Prepare, submit, and manage provider credentialing and payer enrollment applications for commercial, Medicare, Medicaid, and other health plans.

• Coordinate initial credentialing, recredentialing, and provider data maintenance processes for physicians and advanced practice providers.

• Maintain accurate and up-to-date provider files, including CAQH profiles, NPI information, state licenses, DEA certificates, malpractice insurance, board certifications, and other required documentation.

• Maintain all credentialing, enrollment, and contracting records within CredentialStream and other designated databases.

• Monitor credentialing and enrollment statuses through payer portals and follow up regularly to ensure timely approvals.

• Track expiration dates for licenses, certifications, malpractice coverage, and other required documents to ensure continuous compliance.

• Respond to payer requests for additional documentation or clarification in a timely manner.

• Communicate credentialing and enrollment status updates to leadership, billing managers, clinic managers, providers, and other stakeholders as needed.

• Assist with onboarding new providers, including coordinating credentialing timelines, payer enrollments, and hospital privileging requirements.

• Support provider offboarding activities, including payer terminations and record updates.

• Maintain confidentiality and ensure compliance with HIPAA and organizational policies at all times.

Performance Expectations

• Maintains complete, accurate, and organized credentialing and enrollment records.

• Demonstrates timeliness and accuracy in application preparation and submission.

• Effectively manages multiple provider enrollment timelines and deadlines.

• Proactively identifies and resolves credentialing or enrollment delays.

• Maintains professional communication with providers, payers, and internal departments.

• Adheres to HIPAA, confidentiality, and compliance requirements at all times.

Qualifications & Requirements

Education

• High school diploma or equivalent required.

• Associate degree or higher preferred.

Experience

• Minimum of 2 years of experience in provider credentialing, payer enrollment, medical staff services, or healthcare administration required.

• Experience with commercial and government payer enrollment processes strongly preferred.

• Working knowledge of CAQH, PECOS, NPPES, and payer enrollment portals required.

• Experience maintaining provider records and credentialing databases, including CredentialStream or similar credentialing software.

• Experience with hospital privileging and provider onboarding preferred.

• Prior experience in allergy, asthma, or specialty medical practices is a plus.

Skills & Abilities

• Strong attention to detail and organizational skills.

• Excellent written and verbal communication skills.

• Ability to prioritize tasks and manage multiple deadlines effectively.

• Ability to work independently and collaboratively in a remote environment.

• Proficiency in Microsoft Office Suite, EHR systems, practice management software, and online credentialing portals.

• Strong problem-solving and follow-up skills.

Compensation

The hourly range will be discussed during the interview process. Actual compensation will be determined based on a variety of factors, including the candidate's experience, education, skills, and qualifications.

Physical Requirements

Ability to stand, walk, and move throughout the clinic, if applicable, for extended periods; occasionally lift objects up to 25 lbs., bend, stoop, or reach as needed. Frequent use of hands and fingers for patient care and equipment operation. Must have normal (or corrected) vision and hearing and be able to respond quickly in a fast-paced clinical environment, if applicable.

• Competitive salary and benefits package, including medical, dental & vision insurance, 401(k) retirement plan with employer matching, and professional development opportunities
  • In addition, we offer paid time Off (PTO), sick time, floating holiday and holiday pay
• Opportunity to shape the future of a thriving allergy and asthma practice in beautiful San Diego (and across our expanding network)
• A supportive, mission-focused culture where your contributions directly impact patient outcomes and team growth

If this role excites you, please submit your resume and a cover letter outlining your relevant experience and why you're passionate about joining our team. We look forward to hearing from enthusiastic candidates ready to drive our success!

California Consumer Privacy Act (CCPA) Notice
Modena Health ("MH") and Modena Allergy & Asthma ("MAA") complies with the California Consumer Privacy Act ("CCPA"). Personal information provided in the job application process will be collected, used, and retained in accordance with applicable privacy laws. Candidates may request additional information regarding the categories of personal information collected and the purposes for which it is used during the hiring process.