Credentialing Specialist

CredSpun LLC; United States; Remote; USD 60,000 - 80,000; Full time

Job summary

CredSpun LLC is seeking a Remote Credentialing Specialist to manage provider enrollment across CAQH, PECOS, Medicaid and commercial panels, ensuring timely and accurate submissions.

You will collect documents, build CAQH ProView profiles, track applications, and coordinate with payers to secure effective dates and active in-network status.

This role requires two+ years of credentialing experience, strong organization, and professional communication with payer relations teams.

Qualifications

• Two or more years of provider credentialing or payer enrollment experience.
• Hands-on CAQH ProView, NPPES and payer portal experience.
• Familiarity with Medicare enrollment (PECOS, CMS-855I/855B/855R) and state Medicaid enrollment.
• Strong organisation and ability to manage multiple applications.
• Professional telephone manner when contacting payer relations teams.

Responsibilities

• Collect and verify provider documents: licences, DEA, board certification, malpractice, CV, W-9
• Build, audit and re-attest CAQH ProView profiles and grant payer access
• Prepare and submit commercial, Medicare and Medicaid applications and track each by payer
• Follow up with payers on a set schedule and log reference numbers, contacts and outcomes
• Confirm effective dates and loaded contracts before the first claim to each payer is sent
• Track expirables and run re-credentialing and revalidation ahead of deadlines
• Keep a clear status report for each provider that the practice can read at a glance
• Hand enrollment status to the billing team so claims are held or released correctly

Skills

CAQH ProView

NPPES

Payer portal

Organization

Persistence

Tools

CAQH ProView

NPPES

CMS portals

Job description

Remote Credentialing Specialist (Provider Credentialing)

Get providers credentialed and in-network - CAQH, PECOS, Medicaid and commercial panels - and track every application until there is a confirmed effective date.

A practice cannot bill a payer it isn't enrolled with, and claims dated before an effective date are usually lost for good. That makes credentialing the first job in the revenue cycle. As a credentialing specialist you take a provider from a stack of documents to active, in-network status with every payer the practice needs - and you keep them there.

Typical enrollment takes about five months from a complete file, and most of that is payer time. What makes the difference is the part we control: a clean, complete CAQH profile, every application submitted at once, and steady follow-up so nothing sits in a queue unnoticed.

What you will do

• Collect and verify provider documents: licences, DEA, board certification, malpractice, CV, W-9
• Build, audit and re-attest CAQH ProView profiles and grant payer access
• Prepare and submit commercial, Medicare and Medicaid applications and track each by payer
• Follow up with payers on a set schedule and log reference numbers, contacts and outcomes
• Confirm effective dates and loaded contracts before the first claim to each payer is sent
• Track expirables and run re-credentialing and revalidation ahead of deadlines
• Keep a clear status report for each provider that the practice can read at a glance
• Hand enrollment status to the billing team so claims are held or released correctly

What you need

• Two or more years of provider credentialing or payer enrollment experience
• Hands-on CAQH ProView, NPPES and payer portal experience
• Familiarity with Medicare enrollment (PECOS, CMS-855I/855B/855R) and state Medicaid enrollment
• Strong organisation - you will run dozens of applications at different stages
• Persistence and a professional manner on the phone with payer provider-relations teams

Helpful, not required

NAMSS credentials (CPCS or CPMSM), experience credentialing nurse practitioners or behavioral health clinicians (LCSW, LPC, LMFT, psychologists), and group contracting experience.

Working remotely at CredSpun

What types of providers will I credential?

Mostly outpatient physicians, nurse practitioners, psychiatrists and behavioral health clinicians, plus some dental providers, across many U.S. states.

Is credentialing experience required?

Yes, two years or more. If you have billing experience and want to move into credentialing, use the general application and tell us.