Senior Credentialing & Provider Enrolment Specialist - US Healthcare (Remote)

Carepatron; Philippines; Remote; PHP 900,000 - 1,100,000; Full time

Benefits offered by this job

Fully remote

Fixed US-hours schedule

Senior role with influence

Competitive compensation with Incentiv

Job summary

Carepatron is seeking a Senior Credentialing & Provider Enrollment Specialist to lead end-to-end credentialing for US-based clients. You will own applications, follow-ups, payer relationships, and tracking, working with RCM, onboarding, and product teams.

This is a senior IC role with no direct reports, reporting to Head of Customer Success. You will be based in the Philippines, operating on US business hours in a fully remote setup, partnering across Carepatron’s platform to enable faster

Qualifications

• 5+ years of US provider credentialing and payer enrollment.
• Experience with CAQH, NPPES, PECOS, and Medicaid/state portals.
• Ability to manage multi-payer files end-to-end.

Responsibilities

• Own credentialing and enrollment for new RCM clients from application to effective date.
• Build and follow-up with payer relationships, audits, and tracking.
• Maintain HIPAA compliance and renewals; monitor expirables.
• Escalate payers when delays occur and handle denials management.
• Collaborate with onboarding, success, and product teams to automate workflows.
• Serve as SME for the wider RCM team on credentialing best practices.

Skills

Credentialing & enrollment

Payer relations

Multi-state enrollment

English communication

Pipeline management

Education

NAMSS certification (CPMSM/CPCS/CPESM)

Tools

CAQH

NPI setup

PECOS

Availity

Medallion

Verifiable

Modio

HealthStream CredentialStream

symplr

Job description

About Carepatron

Carepatron is one of the fastest-growing AI-native healthcare platforms in the world. We’re building the operating system healthcare practitioners actually want to use: simple, powerful, and designed to get them paid faster with fewer headaches.

Thousands of US healthcare organizations already run their practices on Carepatron. Our RCM service is the next layer on top of that platform. We take on the credentialing, billing, and collections work so practitioners can focus on care, and we’re automating more of it with AI every month.

The Opportunity

We’re hiring a Senior Credentialing & Provider Enrollment Specialist to be the go-to credentialing expert inside Carepatron’s RCM team.

Credentialing is where the clock starts for every new RCM client. Many of the practices joining our billing service are new to insurance billing. They can’t submit a single claim until their providers are enrolled with Medicare and their state Medicaid program, and in-network with the Medicaid managed care plans and commercial payers their patients carry. The faster and cleaner we get that done, the faster they get paid, and the faster Carepatron grows.

You’ll own that outcome end to end on every file you take on: the applications, the follow-ups, the payer relationships, and the tracking.

This is a senior individual contributor role with no direct reports. You’ll take the hardest files, set the standard for how credentialing gets done here, and be the person the team turns to when a payer goes quiet or an application bounces.

You’ll report to our Head of Customer Success and work closely with our RCM, onboarding, and product teams. The role is based in the Philippines and works US business hours.

What You’ll Own

Credentialing and Enrollment, End to End

• Initial credentialing and payer enrollment for new RCM clients: Medicare (PECOS), state Medicaid programs and their managed care plans (MCOs), and commercial payers across multiple states


• Up-to-date Medicare enrollment. MFTs and mental health counselors (including LPCs) have been able to enroll since January 2024, and you catch providers with an active opt-out before they bill


• CAQH profiles (now DataSpring), NPI setup (Type 1 and Type 2), taxonomy codes, and linking providers to their group, including Medicare reassignment, so claims pay correctly from the first submission


• EFT, ERA, and clearinghouse enrollment so payments and remits land where they should


• Payer contracting execution: participation agreements, adding providers to existing group contracts, and tracking contract effective dates and fee schedules


• Re-credentialing, Medicare and Medicaid revalidation, CAQH re-attestation every 120 days, and expirables tracking (licenses, malpractice COI, DEA where applicable) so no provider falls out of network


• The escalation path for when payers stall, lose paperwork, or sit on an application past their stated turnaround, including closed-panel appeals and single case agreements


• HIPAA compliance, monthly exclusion checks (OIG LEIE, SAM.gov, and state Medicaid lists), and payer-specific requirements across every file you touch

Playbook and Quality

• Build and own the credentialing playbook: checklists by payer and state, document collection templates, and a follow-up rhythm that never lets a file go quiet


• Keep a live credentialing tracker that shows every provider’s status, aging, blockers, and expected effective date, visible to the client and to our team


• Track the numbers that matter: time to in-network, first-pass application acceptance, and credentialing-related denials


• Be the subject matter expert for the wider RCM team. Review tricky files, answer the hard questions, and help new teammates get up to speed


• Partner with onboarding and customer success so clients know exactly what we need from them and when they can start billing

Product Partnership

• Work with product and engineering to turn your workflows into automation: document collection, application prefill, status tracking, and payer follow-up


• Tell us which credentialing steps are ready to hand to software and which still need a human. We’re automating RCM aggressively and credentialing is next


• Shape how credentialing shows up inside the Carepatron platform so it becomes something practitioners barely have to think about

What You Bring

• 5+ years of hands-on US provider credentialing and payer enrollment, including complex multi-payer files you’ve carried from application to effective date


• Hands-on with CAQH, NPPES, PECOS, state Medicaid portals, and commercial payer enrollment through Availity and payer-specific portals


• Multi-state experience. You know Medicaid in Texas works nothing like Medicaid in California, and you’ve handled both


• You know what payers verify and why applications bounce: work history gaps, malpractice history, and name and address mismatches across NPPES, CAQH, and the W-9


• Fluent in the plumbing: EFT and ERA enrollment, taxonomy codes, group versus individual enrollment, and how an effective date flows through to a clean claim


• Experience credentialing behavioral health, ABA, therapy, and allied health providers (LCSWs, LPCs, LMFTs, psychologists, BCBAs, SLPs, OTs, PTs), including pre-licensed clinicians billing under supervision, where payer rules are at their most inconsistent


• Self-directed and analytical. You manage your own pipeline, spot aging files before they become problems, and report on time to in-network without being asked


• A clear communicator in English, written and spoken. Comfortable on the phone with a payer rep and on a call with a client explaining why an enrollment is taking months, not weeks


• Based in the Philippines and able to work a fixed US business hours schedule consistently

What Makes You Stand Out

• You’ve been the senior specialist or SME your team relied on, or you’ve built a credentialing playbook from scratch that others still use


• Experience inside a US RCM company, healthcare BPO, or credentialing vendor serving many practices at once, not just one health system


• Experience with telehealth and multi-state providers, and you understand what interstate compacts like PSYPACT and the Counseling Compact mean for licensure and enrollment


• Familiarity with credentialing software (Medallion, Verifiable, Modio, HealthStream CredentialStream, symplr) and an opinion on what they get wrong


• A track record of measurably cutting time to in-network or credentialing-related denials, with numbers to back it up


• NAMSS certification (CPES, CPCS, or CPMSM) is a plus

Why Carepatron

• A mission-driven team improving life for healthcare professionals worldwide


• Fully remote, with a fixed US-hours schedule and a team that trusts you to run your own day


• A senior seat with real influence and no people-management overhead. You’ll shape how credentialing works at Carepatron rather than inherit a legacy process, and the role grows as RCM scales


• Competitive compensation with performance incentives


• Work alongside world-class designers, engineers, and operators shaping the future of healthcare software\\