Credentialing & Payer Enrollment Specialist

Toi Health; United States; Remote; USD 42,000 - 64,000; Full time

Job summary

Toi Health is seeking a Credentialing Specialist to manage end-to-end credentialing and recredentialing for healthcare providers within the Revenue Cycle Management framework. You will enroll providers with payers, maintain CAQH records, and support compliant reimbursement.

You will collaborate with providers, payers, and internal teams to gather documentation, track statuses, and resolve discrepancies, ensuring timely submissions and no credentialing gaps.

Qualifications

• High school diploma or equivalent; associate or bachelor’s degree preferred.
• Minimum 2 years in healthcare credentialing or provider enrollment.
• Experience with commercial and government payers preferred.
• Proficiency with credentialing software, payer portals (CAQH, PECOS), and MS Office.
• Knowledge of HIPAA and healthcare compliance regulations.

Responsibilities

• Complete initial credentialing and recredentialing applications for providers with payers.
• Maintain provider information in credentialing databases and payer portals.
• Maintain up-to-date CAQH profiles with regular updates.
• Monitor licenses, certifications, and contract renewals.
• Communicate with providers to collect documentation and resolve discrepancies.
• Collaborate with billing teams to avoid delays in claims processing.
• Respond to payer requests for additional documentation.
• Ensure compliance with credentialing guidelines and timelines.
• Audit credentialing records for data integrity and policy compliance.
• Maintain logs and reports of credentialing activities and contract dates.

Skills

Team Player

Integrity & Accountability

Highly Organized

Detail-Oriented

Persistent & Proactive

Problem-Solver

Confidential & Compliant

Effective Communicator

Education

High school diploma or equivalent

Associate or Bachelor's degree in healthcare administration or related field preferred

Tools

CAQH

PECOS

Microsoft Office Suite

Excel

Outlook

Job description

Toi Health is seeking a Credentialing Specialist to manage end-to-end credentialing and recredentialing for healthcare providers within the Revenue Cycle Management framework. You will enroll providers with payers, maintain CAQH records, and support compliant reimbursement.

You will collaborate with providers, payers, and internal teams to gather documentation, track statuses, and resolve discrepancies, ensuring timely submissions and no credentialing gaps.