Credentialing Specialist

🔥 6 minutes ago

🇺🇸 United States – Remote

💵 $60k - $65k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

👻 Ghost score 7%

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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Holon Health

WebsiteLinkedInAll Job Openings

2 - 10 employees

Founded 2023

🏥 Healthcare

☁️ SaaS

💰 $200k Pre seed on 2023-11

Healthcare • SaaS

Holon Health is a healthcare provider focused on accessible, low-to-no-cost care and recovery support for people living with substance use disorder and related mental health concerns. They offer primary care, telehealth appointments, prescriptions, peer and recovery coaching, and 24/7 support through their Holon Vibe app, which also uses contingency management rewards for engagement. Holon serves clients directly and partners with courts, community organizations, health plans, and providers; their services are covered by Medicaid, Medicare, and most marketplace plans.

📋 Description

• Coordinate initial credentialing, recredentialing, and payer enrollment for physicians, advanced practice providers, and other licensed clinicians • Manage Medicare, Medicaid, and commercial payer enrollment applications across multiple states • Perform primary source verifications and revalidations • Submit and manage provider demographic updates, location additions, participation requests, and other enrollment changes • Monitor applications through completion and follow up with payers to resolve delays or discrepancies • Maintain provider credentialing files, databases, and reporting systems • Monitor and update CAQH, PECOS, NPPES, Availity, and state enrollment systems • Track and manage expirations for licenses, DEA registrations, malpractice insurance, board certifications, attestations, and other credentials • Maintain compliance with Holon Health policies, NCQA standards, CMS requirements, and state and federal regulations • Prepare documentation for audits, accreditation reviews, and payer credentialing requests • Support provider onboarding and new market expansion • Maintain provider rosters and coordinate submissions to participating health plans • Respond to credentialing inquiries from providers, health plans, regulatory agencies, and internal stakeholders • Manage credentialing inboxes and daily workflows, including approvals, denials, appeals, and payer correspondence • Partner with Operations, Leadership, Contracting, and Compliance teams • Identify process improvements to increase efficiency, accuracy, and turnaround times

🎯 Requirements

• At least five (5) years of experience in healthcare credentialing, provider enrollment, medical staff services, or a related area • Bachelor’s degree in Healthcare Administration, Business Administration, or a related field preferred • Equivalent experience will be considered • Strong knowledge of credentialing and recredentialing, payer enrollment workflows, and primary source verification • Experience with Medicare, Medicaid, and commercial health plans • Experience managing credentialing and enrollment across multiple states • Proficiency with credentialing systems, provider portals, and Microsoft Office • Strong organizational skills, attention to detail, and follow-through • Ownership and accountability for accurate, audit-ready work • Ability to manage multiple priorities and meet deadlines in a dynamic environment • Clear written and verbal communication with providers, payers, and internal teams • Experience with Modio or another credentialing database nice to have • Experience with telehealth or integrated healthcare models nice to have • Experience developing and implementing delegated credentialing processes nice to have

🏖️ Benefits

• Unlimited PTO • Flexible schedules • Remote-first culture • Health insurance • Dental insurance • Vision insurance • Life insurance • Disability insurance • 401(k) with company match • Space for self-care • Room to grow in a high-impact, mission-driven startup • Team that celebrates wins, learns from losses, and provides support