Licensing & Credentialing Specialist

Job not on LinkedIn

🔥 1 minute ago

Apply Now

Find Similar Remote Jobs

Set Up Email Alert For New Jobs

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume

CareTalk Health

WebsiteLinkedInAll Job Openings

51 - 200 employees

Founded 2021

🏥 Healthcare

🤝 B2B

Healthcare • B2B

CareTalk Health is a Clinical Process Outsourcing (CPO) company and virtual national medical practice that delivers virtual health solutions to healthcare organizations across the United States. It provides telehealth-focused clinical services and administrative processes that can be Medicare-billed when applicable, supporting Medicare and Medicaid populations. CareTalk operates as a virtual provider partner, enabling remote care delivery and revenue-cycle–eligible services for other healthcare entities.

📋 Description

• Manage full-cycle provider credentialing and recredentialing processes in compliance with CMS, NCQA, and state regulatory requirements • Oversee medical payer enrollment activities, ensuring timely and accurate submission of applications to commercial payers and government entities (e.g., Medicare) • Complete and manage PECOS and CMS 855i enrollments and updates • Partner with providers to maintain and update CAQH profiles to ensure accuracy and attestation compliance • Maintain and track provider records in credentialing databases, ensuring data integrity, accuracy, and confidentiality • Track and manage active licenses and expiration dates via Modio for: • Physicians and Advanced Practice Providers • Registered Nurses (RNs) • Licensed Vocational Nurses (LVNs) • Licensed Practical Nurses (LPNs) • Proactively monitor expirations and coordinate renewals via Modio to ensure uninterrupted compliance and ability to practice • Maintain working knowledge of all 50-state licensure and practice requirements impacting telehealth delivery • Research and interpret state-specific regulations, including: • Nurse Practitioner collaborative/supervisory agreement requirements • Scope of practice variations by state • Establish and maintain processes to ensure compliance with varying state laws and regulatory updates • Coordinate and manage collaborative agreements in accordance with state-specific requirements • Monitor credentialing status and proactively resolve issues or delays with payers and regulatory agencies • Conduct thorough review of credentialing applications in alignment with NCQA and accreditation standards • Maintain provider data across platforms including CAQH, NPPES, PECOS, and payer portals • Maintain comprehensive databases of provider information, ensuring accuracy and confidentiality • Handle sensitive information with strict adherence to HIPAA and healthcare privacy standards • Collaborate cross-functionally with recruiting, operations, and compliance teams to ensure timely onboarding

🎯 Requirements

• 3+ years of experience in healthcare credentialing, licensing, and payer enrollment • Strong knowledge of CMS regulations, Medicare enrollment processes, and multi-state licensing requirements • Hands-on experience with CAQH, PECOS, NPPES, and payer portals • Experience managing 855i applications and Medicare provider enrollment workflows • Demonstrated experience tracking multi-state licensure and expirations for providers and nursing staff (RNs, LVNs, LPNs) • Experience researching and applying state-specific regulatory requirements, including NP collaborative agreements • Knowledge of credentialing standards including NCQA • Strong database management experience within credentialing systems • Exceptional organizational skills with strong attention to detail

🏖️ Benefits

• 100% Remote