Credentialing Specialist

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🇺🇸 United States – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

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Heartbeat Health

WebsiteLinkedInAll Job Openings

11 - 50 employees

⚕️ Healthcare Insurance

📡 Telecommunications

Healthcare Insurance • Telecommunications

Heartbeat Health is a revolutionary healthcare company focused on transforming cardiovascular care through virtual-first cardiology. By leveraging device connectivity and real-time clinical data, they provide accessible, high-quality cardiovascular care remotely, offering services such as televisits, same-day diagnostic reads, and comprehensive care programs. Heartbeat Health aims to make heart health care more accessible and effective, using a nationwide model that allows for coordinated delivery between patients, cardiologists, and primary care physicians. They collaborate with various partners to create a seamless, connected health experience, both synchronously and asynchronously. Their approach simplifies complex care processes into manageable steps, improving patient outcomes and engagement, especially in regions with limited access to cardiologists.

📋 Description

• This role is responsible for end-to-end provider credentialing and payer enrollment across government and commercial payers, ensuring providers are set up for success in a multi-state, virtual care environment. • Complete and manage all aspects of initial credentialing, re-credentialing, and payer enrollment for a large network of telehealth providers across the U.S. • Submit and track applications with government payers (Medicare, Medicaid, VA, Tricare) and commercial/private payers to ensure active participation status. • Lead and mentor credentialing staff, providing training, guidance, and quality checks. • Serve as the subject matter expert (SME) for credentialing, payer enrollment, and their connection to revenue cycle processes • Optimize credentialing turnaround time and reduce payer enrollment delays that impact revenue • Stay up to date on payer regulations and credentialing requirements across all states where the organization provides telehealth services • Analyze denial trends related to credentialing/enrollment issues and implement corrective actions • Track payer roster accuracy and manage data integrity between credentialing systems and billing systems. • Maintain accurate provider records in credentialing systems (e.g., CAQH, payer portals, internal databases), ensuring information is current and compliant. • Verify provider credentials including education, training, board certification, work history, malpractice history, and references. • Ensure provider enrollment aligns with billing requirements, reducing claim denials and reimbursement delays for a streamlined Revenue Cycle Management (RCM) process • Monitor payer rosters and enrollment timelines to proactively resolve issues that may impact revenue. • Support the onboarding of new providers by ensuring credentialing and enrollment are completed prior to patient scheduling. • Prepare reports on credentialing status, payer enrollment progress, and upcoming expirations for leadership and compliance purposes. • Assist with audits, quality checks, and process improvements to ensure compliance.

🎯 Requirements

• High school diploma or equivalent required; Associate’s or Bachelor’s degree in Healthcare Administration or related field preferred. • 5-7 years of experience in healthcare credentialing and payer enrollment (telehealth or multi-state experience strongly preferred). • Strong knowledge of government and commercial payer enrollment requirements • Familiarity with RCM processes and how credentialing impacts reimbursement • Proficiency with credentialing platforms and payer portals (e.g., CAQH) • Excellent organizational skills with the ability to manage multiple providers and payers across states • High attention to detail, accuracy, and ability to meet strict deadlines

🏖️ Benefits

• We are mission-driven: we're revolutionizing the way cardiovascular care is delivered • We are fast-paced & agile: we move quickly, iterate often, and value experimentation • We are remote-first: flexibility, autonomy, and trust are at the core of how we operate • We care about diversity: diversity allows us to build an excellent patient experience • We are an equal opportunity employer: we do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status