Credentialing Specialist

Circadia Technologies Ltd; Los Angeles (CA); On-site; USD 65,000 - 115,000; Full time

Job summary

A healthcare technology company is seeking a Credentialing Manager to oversee provider credentialing and payer enrollment processes. This role is crucial for ensuring compliance and operational efficiency as the company scales. The ideal candidate will have extensive experience in healthcare credentialing, strong organizational skills, and the ability to manage multiple priorities in a dynamic environment.

Benefits

Full healthcare coverage

Employee contribution to 401(k)

Paid Time Off (PTO)

Paid education/professional development stipend

Qualifications

• 5+ years of experience in healthcare credentialing and payer enrollment.
• Strong understanding of credentialing standards and payer processes.

Responsibilities

• Lead end-to-end provider credentialing and recredentialing processes.
• Manage provider enrollment with Medicare, Medicaid, and commercial insurers.
• Implement best practices to reduce turnaround time and improve accuracy.

Skills

Detail-oriented

Deadline-driven

Proficiency with CAQH

Proficiency with PECOS

Education

CPCS certification

CPMSM certification

Tools

Google Suite

Slack

Job description

Circadia Health is a healthcare technology company that has developed the world's first FDA cleared contactless remote patient monitoring system and AI-powered early detection system. Powered by cutting-edge technology and AI, the system allows for the early detection of medical events such as Congestive Heart Failure, COPD Exacerbations, Pneumonia, Sepsis, UTIs, and Falls. We're monitoring over 30,000+ patients daily and growing rapidly. As we scale our team, Circadia is looking for energetic, personable, and solutions-oriented individuals driven by creating the ultimate customer experience. Our mission is to enhance patient outcomes and improve healthcare processes by providing cutting-edge solutions to healthcare providers and patients alike.

Circadia Health is transforming remote patient monitoring for skilled nursing facilities and post-acute care. We are seeking a highly organized and experienced Credentialing Manager to oversee all provider credentialing and payer enrollment processes. This role is critical to ensuring our clinicians are fully onboarded, compliant, and able to deliver care without delay. You'll lead credentialing operations across multiple states and collaborate cross-functionally to support provider readiness as we scale.

Key Responsibilities

• Credentialing & Compliance
• Lead end-to-end provider credentialing and recredentialing processes across all markets
• Conduct primary source verification for licenses, education, board certifications, and malpractice history
• Maintain complete, accurate provider records across internal systems and CAQH
• Monitor expirables such as licenses, DEA, board certs, and malpractice insurance
• Identify and document adverse actions or red flags for internal review
• Act as the primary contact for credentialing status between internal teams, providers, and payers

• Payer Enrollment
• Manage provider enrollment with Medicare, Medicaid, and commercial insurers
• Complete and submit enrollment forms including 855I, 855B, and 855R
• Track enrollment status through PECOS, CAQH, and payer portals
• Resolve delays, denials, or RFIs to avoid billing or onboarding disruptions
• Communicate enrollment progress to Recruiting, Billing, and Clinical Operations teams
• Stay up-to-date on changes in payer requirements and documentation standards

• Process Optimization
• Use PECOS, CAQH, and payer portals to track credentialing and enrollment workflows
• Implement best practices to reduce turnaround time and improve accuracy
• Monitor SLAs and KPIs and drive continuous process improvement
• Support the scalability of credentialing operations in a fast-paced, multi-state environment

KPIs

• Credentialing Turnaround Time - ≤ 30 days from complete application submission
• Payer Enrollment Completion Rate - ≥ 90% completed within 45–60 days, depending on payer and state
• Provider Satisfaction - >90% positive feedback on onboarding and credentialing support

Qualifications

• 5+ years of experience in healthcare credentialing and payer enrollment
• CPCS or CPMSM certification preferred
• Strong understanding of credentialing standards (CMS, NCQA) and payer processes
• Proficiency with CAQH, PECOS, and payer portals
• Detail-oriented, deadline-driven, and capable of managing multiple priorities
• Comfort using technology such as Google Suite, Slack, CAQH, PECOS, and payer portals
• Comfortable in a dynamic and always evolving start up environment

Benefits

• Full healthcare coverage with Anthem BCBS (or similar) with dental and vision
• Employee contribution to 401(k) retirement plan
• Paid Time Off (PTO) accrual policy of 1.7 working days per month
• Paid education/professional development stipend of up to $2,500 per year based on approval
• Collaborative environment, working directly with designers, engineers, scientists, and clinicians

$65,000 - $115,000 a year