Credentialing Specialist

This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for a Credentialing Specialist based in the United States. This role offers the opportunity to support the growth of a nationwide virtual healthcare network by ensuring providers can deliver care efficiently and compliantly. You will manage critical credentialing and payer enrollment processes that directly impact provider onboarding, reimbursement, and patient access. The position combines healthcare operations, compliance, payer relationships, and revenue cycle collaboration in a fast-moving digital care environment. You will serve as a key expert connecting providers, payers, and internal teams to streamline processes and improve operational performance. Working across multiple states and healthcare systems, you will help remove administrative barriers and support high-quality virtual care delivery. This is an impactful opportunity for a credentialing professional who enjoys improving healthcare operations through accuracy, collaboration, and process optimization. Accountabilities: The Credentialing Specialist will oversee end-to-end provider credentialing and payer enrollment activities, ensuring healthcare professionals are properly enrolled, compliant, and ready to support patient care. This role requires strong attention to detail, knowledge of healthcare payer requirements, and the ability to improve processes across credentialing and revenue cycle operations.

Manage initial credentialing, re-credentialing, and payer enrollment processes for a large network of healthcare providers across multiple states. Submit, monitor, and maintain applications with government payers, including Medicare, Medicaid, VA, and Tricare, as well as commercial insurance organizations. Maintain accurate provider records across credentialing systems, payer portals, and internal databases. Verify provider credentials, including education, training, certifications, employment history, malpractice history, and professional references. Ensure provider enrollment activities align with billing requirements to minimize claim denials and reimbursement delays. Serve as a subject matter expert on credentialing processes, payer requirements, and their impact on revenue cycle management. Lead and support credentialing team members through training, guidance, quality reviews, and process improvements. Monitor credentialing timelines, payer participation status, and provider rosters to proactively resolve enrollment issues. Analyze credentialing-related denial trends and implement corrective actions to improve operational efficiency. Support provider onboarding by ensuring all credentialing and enrollment requirements are completed before patient scheduling. Prepare reports on credentialing status, enrollment progress, expirations, and compliance metrics for leadership teams. Assist with audits, quality assurance reviews, and continuous improvement initiatives. Requirements: The ideal candidate is an experienced healthcare credentialing professional with strong knowledge of payer enrollment processes, provider compliance requirements, and healthcare operations. You should be organized, detail-oriented, and comfortable managing complex workflows in a remote, multi-state environment.

High school diploma or equivalent required; Associates or Bachelors degree in Healthcare Administration or a related field preferred. 5-7 years of experience in healthcare credentialing and payer enrollment. Experience supporting telehealth organizations, multi-state provider networks, or virtual care environments strongly preferred. Strong understanding of government and commercial payer enrollment requirements. Knowledge of credentialing processes and how they impact revenue cycle management and reimbursement. Experience working with credentialing platforms and payer portals such as CAQH. Strong organizational skills with the ability to manage multiple providers, payers, deadlines, and priorities. Excellent attention to detail and commitment to maintaining accurate records. Strong communication skills with the ability to collaborate effectively with providers, payers, and internal teams. Ability to identify process improvements and implement solutions in a fast-paced environment. Self-motivated, adaptable, and comfortable working independently in a remote-first organization. Benefits:

Fully remote work opportunity with flexibility and autonomy. Opportunity to contribute to improving healthcare access through innovative virtual care solutions. Mission-driven environment focused on transforming cardiovascular healthcare delivery. Collaborative culture built around innovation, experimentation, and continuous improvement. Opportunity to work with healthcare professionals, operational teams, and technology-driven solutions. Professional growth opportunities within a rapidly expanding healthcare organization. Supportive workplace that values diversity, inclusion, and different perspectives. Ability to make a direct impact on provider operations and patient care outcomes. How Jobgether works: We use an AI-powered matching process to ensure your application is reviewed quickly, objectively, and fairly against the roles core requirements. Our system identifies the top-fitting candidates, and this shortlist is then shared directly with the hiring company. The final decision and next steps (interviews, assessments) are managed by their internal team. We appreciate your interest and wish you the best!

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