Credentialing & Enrollment Specialist II

🕒 August 12

🇺🇸 United States – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

👻 Ghost score 28%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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Brightside Health

WebsiteLinkedInAll Job Openings

51 - 200 employees

🛡️ Insurance

💼 Consulting

🏥 Healthcare

Insurance • Consulting • Healthcare

Brightside Health is an online mental health service provider that offers personalized care for individuals experiencing anxiety, depression, PTSD, bipolar disorder, and more. They provide both therapy and psychiatric services, including medication management, through a virtual platform. Brightside takes a personalized approach with 1:1 support, quick access to licensed professionals, and a focus on measurable results. Their innovative offerings include a Crisis Care program specifically for individuals with a high risk of suicide. The service is designed to be accessible and is covered by insurance, providing convenient mental health care options for patients aged 13 and up.

📋 Description

• Execute provider onboarding readiness tasks and intake packet completeness checks • Prepare and submit initial credentialing and re-credentialing applications • Submit and monitor primary source verifications through CVO • Perform PSV according to departmental policies and NCQA standards when not completed by CVO • Review CVO-processed files for completeness and accuracy • Process provider status changes, terminations, and reactivations • Collect and follow up on missing provider documentation • Track and manage provider expirables and renewal timelines • Complete and submit group and individual enrollment applications to commercial and government payers • Follow up on submitted enrollment applications through completion • Execute roster additions, updates, and terminations as directed by Senior IC • Correct roster discrepancies • Maintain payer contact lists and portal access • Track enrollment statuses and update Salesforce accordingly • Manage CAQH and PECOS profile maintenance • Follow up on payer issue tickets and cases • Handle provider onboarding communications, status update requests, and documentation guidance • Manage provider issue intake and routing • Follow up with providers on missing items • Support enrollment-related claim denial triage • Help resolve roster-related billing issues • Gather audit evidence as directed by Senior IC • Prepare delegated credentialing files • Perform credentialing file QA • Collect and verify provider malpractice policies and insurance documents • Track insurance expiration dates and follow up on renewals • Ensure provider demographic data is current across credentialing systems, CAQH, and payer records • Maintain credentialing platform records and internal trackers • Maintain payer portal accounts • Report directly to the Manager, Credentialing and Enrollment • Serve as an experienced cross-functional operator and resource for Credentialing Specialist I team members

🎯 Requirements

• 3+ years of experience in credentialing and/or enrollment operations • Experience with group-level Medicaid enrollment • Working knowledge of NCQA standards, CAQH, and payer enrollment processes • Experience with both commercial and government payer enrollment preferred • Proficiency with payer portals (CAQH, PECOS, Availity, payer-specific) • Strong attention to detail and documentation habits • Ability to manage multiple priorities and meet deadlines consistently

🏖️ Benefits

• A competitive salary • Fully paid for comprehensive health care (medical, dental, vision) • Pet Insurance • Life Insurance & Short / Long Term Disability • 401k Plan • Unlimited PTO and sick leave • Parental Leave • Work remotely and whatever schedule works best for you • Additional memberships and perks • Continuous learning opportunities • Cross-functional collaboration • Equal employment opportunities based on merit, competence, and performance