Credentialing Specialist

🕒 June 10

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Insight Therapy Solutions

WebsiteLinkedInAll Job Openings

51 - 200 employees

Founded 2012

⚕️ Healthcare Insurance

🧘 Wellness

📚 Education

Healthcare Insurance • Wellness • Education

Insight Therapy Solutions is a mental health service provider that emphasizes connection and personalized care. They specialize in teletherapy, offering accessible therapy options tailored to individual needs, budgets, and comfort levels. The company believes in meeting clients where they are emotionally and physically, providing a safe and private environment for therapy sessions regardless of location. This allows clients to engage in effective therapy without the constraints of traditional settings.

📋 Description

• Manage initial credentialing, enrollment, and recredentialing processes for providers across commercial, Medicare, and Medicaid payers. • Prepare, submit, track, and follow up on credentialing applications through approval. • Coordinate provider onboarding activities related to payer enrollment and network participation. • Complete government payer revalidation and enrollment updates as required. • Maintain accurate provider records across CAQH, PECOS, NPPES, CMS, and other credentialing platforms. • Ensure provider files remain complete, current, and audit-ready. • Monitor credential expiration dates and proactively manage renewals. • Maintain credentialing documentation in accordance with payer and regulatory requirements. • Support provider enrollment with commercial insurance plans, Medicare, and Medicaid. • Assist with payer communications and issue resolution. • Participate in fee schedule review and contract negotiations when applicable. • Track credentialing and enrollment statuses to minimize delays in provider activation. • Partner with Clinical HR, Billing, and Operations teams to resolve credentialing-related issues impacting provider participation or reimbursement. • Communicate progress, risks, and timelines to managers and leadership. • Identify opportunities to improve credentialing workflows, processes, and tracking systems.

🎯 Requirements

• 2+ years of healthcare credentialing experience with U.S.-based healthcare organizations. • Hands-on experience with commercial payer credentialing and provider enrollment. • Experience managing CAQH, PECOS, NPPES, CMS, and related credentialing systems. • Strong understanding of Medicare, Medicaid, and commercial insurance credentialing processes. • Excellent organizational and documentation skills. • Strong written and verbal English communication skills. • Ability to manage multiple credentialing projects and deadlines simultaneously. • Proficiency with Google Workspace, spreadsheets, and credentialing databases.

🏖️ Benefits

• Paid Time Off (PTO, 10 days annually) • Paid U.S. holidays • Paid birthday leave • Parental leave • Monthly health stipend