Provider Credentialing Specialist

Job Description

Job Description

Job Title: Provider Credentialing Specialist
Primary Location: 100% Remote
Position Type: Contract (6 Months to 1 Year)

Overview
TalentFish is casting a line for a Provider Credentialing Specialist. This is a 6-month to 1-year full-time contract role, working 100% remote.

This position exists to support hands-on payer credentialing and provider enrollment, with a strong focus on behavioral health providers. The Credentialing Specialist will also play a key role in cleansing and validating credentialing data as the organization transitions to MD-Staff. We're looking for someone who has personally done the work, not just overseen or coordinated it. Contractors may be considered for permanent openings as opportunities arise.

What You Bring to the Role. (Ideal Experience)

• 2+ years of direct, hands-on provider credentialing and/or payer enrollment experience.
• Proven ability to independently manage payer enrollment end to end: preparing and submitting applications, tracking payer responses, resolving deficiencies, and maintaining provider participation records.
• Experience credentialing and enrolling behavioral health providers (LCSWs, LPCs, psychologists, psychiatrists, etc.) and working within payer-specific requirements is strongly preferred.
• Hands-on experience with Cactus and/or MD-Staff is strongly preferred; experience with both is ideal.
• Experience with credentialing data cleansing, validation, reconciliation, and resolving duplicate or incomplete records, ideally as part of a system transition.
• Working knowledge of initial credentialing, recredentialing, primary source verification, NPDB queries, CAQH profile maintenance and re-attestation, and Medicare/Medicaid revalidations.
• Experience with CAQH and payer portals; strong computer and data-entry skills.
• Strong attention to detail, organization, and the ability to manage a workload independently.
• Clear, professional communication with providers, practices, payers, and internal teams, and a firm commitment to confidentiality.
• High school diploma or GED required; associate degree preferred.
• CPCS certification preferred.

What You'll Do. (Skills Used in this Position)

• Process and track initial payer credentialing, provider enrollment, recredentialing, and revalidation applications for participating providers.
• Support behavioral health provider credentialing and enrollment, including collecting and reviewing payer-required documentation.
• Prepare, assemble, review, and quality-check provider applications, following up with providers and payers to resolve missing or inconsistent information.
• Conduct credential verifications and mandated queries in line with organizational policy and payer requirements.
• Enter, maintain, and update provider information in credentialing databases, CAQH, and payer systems.
• Cleanse and validate credentialing and provider records to support the MD-Staff transition, flagging incomplete, outdated, or inconsistent data and coordinating corrections.
• Monitor provider expirables, enrollment status, recredentialing deadlines, and payer revalidation cycles while keeping documentation and status tracking current.
• Partner with providers, practice managers, medical staff offices, and payer representatives to keep credentialing and enrollment moving on time.
• Prepare reports and updates for downstream billing and system maintenance, and help resolve enrollment-related claim issues.
• Protect confidential provider information and follow privacy, compliance, and quality procedures.

Compensation Information
The expected salary range for this position is $25-28 per hour, depending on experience and qualifications. This role also qualifies for comprehensive benefits such as health insurance, 401(k), and paid time off. TalentFish is committed to pay transparency and equal opportunity. The salary range provided is in compliance with applicable state and federal regulations.
This role requires authorization to work in the U.S. without current or future visa sponsorship.
All offers are contingent upon the completion of a background check, which may include but is not limited to reference checks, education verification, employment verification, drug testing, criminal records checks, and any required certifications or compliance requirements based on the end client's background check policies and applicable laws.
TalentFish is an employee-owned company pioneering a new realm in talent acquisition. We are redefining IT staffing by evolving AI, video screening, and our unique platform. TalentFish focuses on providing the best employee, consultant, and client experience possible. At TalentFish we are an Equal Opportunity Employer; we embrace and encourage diversity!