Licensing and Credentialing Specialist

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🌵 Arizona, Florida, +10 more states – Remote

🌵 Arizona – Remote 🐊 Florida – Remote 🥔 Idaho – Remote ⚜️ Louisiana – Remote 🗻 New Hampshire – Remote 🌲 North Carolina – Remote 🏰 Missouri – Remote 🌴 South Carolina – Remote 🎸 Tennessee – Remote 🤠 Texas – Remote 🍁 Vermont – Remote ⚔️ Virginia – Remote

💵 $65k - $75k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

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Connecting for Better Health

WebsiteLinkedInAll Job Openings

1 - 10 employees

Founded 2021

⚕️ Healthcare Insurance

🤝 Non-profit

🌍 Social Impact

Healthcare Insurance • Non-profit • Social Impact

Connecting for Better Health is a nonprofit coalition dedicated to improving health and social service data sharing in California. The organization brings together providers, caregivers, health plans, advocates, and community organizations to collaborate on enhancing data sharing policies. Their initiative promotes the Data Exchange Framework (DxF), which aims to facilitate secure and efficient exchanges of health and social services information to support better whole-person care.

📋 Description

• Own the end-to-end payer enrollment process for new and existing providers, including initial enrollments, revalidations, demographic updates, terminations, and maintenance across commercial, Medicare, and Medicaid health plans. • Submit, track, and proactively follow up on payer enrollment applications to ensure timely provider participation and minimize delays to patient care and revenue. • Serve as the primary point of contact with national and local health plans, delegated credentialing organizations, CVOs, and internal stakeholders to resolve enrollment issues, missing information requests, and payer escalations. • Maintain accurate provider data across payer portals, CAQH, credentialing systems, and internal tracking tools, ensuring consistency across all platforms. • Support delegated credentialing activities by maintaining provider rosters, submitting required updates, monitoring compliance requirements, and preparing documentation for internal and external audits. • Conduct routine audits of provider enrollment and credentialing files to ensure compliance with NCQA, CMS, state, and payer-specific requirements. • Monitor key enrollment and credentialing metrics, identify risks to provider participation, and communicate status updates and timelines to leadership and cross-functional partners. • Collaborate closely with Licensing, Practice Operations, Revenue Cycle, Recruiting, and Clinical Operations teams to ensure providers are fully credentialed, enrolled, and ready to see patients on schedule. • Identify opportunities to improve enrollment and credentialing workflows through process standardization, documentation, automation, and operational efficiencies. • Support provider licensing activities as needed, including coordinating new state license applications, renewals, cross-licensure efforts, and maintaining accurate licensure records. • Monitor provider licenses, DEA and CDS registrations, board certifications, malpractice coverage, and other required credentials to ensure continuous compliance. • Provide exceptional support to providers throughout the enrollment, credentialing, and licensing process by communicating requirements, timelines, and next steps clearly and proactively.

🎯 Requirements

• Bachelor’s Degree in Healthcare administration or related field • 3+ years of experience in provider payer enrollment and credentialing • Experience managing provider enrollments with commercial, Medicare, and Medicaid payers. • Experience supporting delegated credentialing activities, including provider rosters, ongoing monitoring, or audit preparation. • Experience with multi-state or national provider organizations. • Working knowledge of CAQH, payer portals, and provider credentialing systems. • Understanding of NCQA, CMS, state licensing, and payer credentialing requirements. • Strong organizational skills with the ability to manage multiple priorities and deadlines. • Excellent attention to detail and written and verbal communication skills. • Proficiency with Google Workspace, including Google Sheets.

🏖️ Benefits

• Employer-sponsored medical, dental, and vision coverage • Unlimited PTO + 11 paid company holidays • Eligibility to contribute to 401(k) • Tailored professional development opportunities as we scale • Access to Overalls, because we know life happens