Credentialing Specialist

Visa Hunt; United States; On-site; USD 60,000 - 70,000; Full time

Job summary

LifeMD is seeking a Credentialing Specialist to support licensing, credentialing and payer enrollment across multiple states. You will credential/re-credential providers with insurance payors and hospitals, maintain CAQH records, and coordinate with internal teams to onboard or offboard providers while ensuring compliance and accuracy.

Strong organizational skills, attention to detail, and the ability to manage confidential information are essential as you verify licenses, degrees and

Qualifications

• Bachelor's degree or equivalent in business or healthcare administration.
• Credentialing certification or CPCS/CPMSM/CPES preferred.
• 2+ years in credentialing or related admin roles.

Responsibilities

• Credential/re-credential LifeMD providers with payors/hospitals; maintain CAQH records.
• Maintain credentialing matrices for providers across markets/states.
• Follow up with insurance payors on credentialing matters.
• Coordinate onboarding/offboarding with LifeMD departments.
• Assist providers with credentialing, licensing, and payor questions.
• Obtain licensure/privileges for providers.
• Create and update provider credentialing rosters.
• Verify licensure, malpractice, and education by external research.
• Check payor websites for directory accuracy and updates.
• Meet payor application submission expectations.
• Perform confidential administrative tasks, draft correspondence, and handle routine external communications.
• Protect provider and LifeMD information; maintain confidentiality.
• Lead or support special projects and data updates for the Director of Payor Enrollment.
• Show reliability by reporting on time for scheduled hours.
• Perform other related duties as required.

Skills

Credentialing

Licensing

Payor enrollment

Analytical skills

Regulatory knowledge

Communication skills

Time management

Team collaboration

Education

Bachelor's Degree in Business Administration/Healthcare Administration

Credentialing Certification

Equivalent experience

Tools

Credentialing software

Job description

About Us

LifeMD is a leading provider of virtual primary care, telehealth, and specialized treatment programs serving hundreds of thousands of patients nationwide. Our vertically integrated platform combines 50-state licensed providers, in-house pharmacy and lab integrations, and proprietary technology that enables safe, high-quality, and affordable care.

At the heart of this transformation is our team of developers, engineers, and tech innovators building state-of-the-arc systems that make healthcare smarter, faster, and more accessible. From architecting scalable backend systems to crafting intuitive user experiences, we are pushing boundaries every day.

Recognized as one of the fastest-growing healthcare tech companies (#166 on Deloitte Fast 500 in 2023), LifeMD is not just a healthcare company — it's a tech company revolutionizing healthcare.

About the Role

The Credentialing Specialist reports to the Director of Payor Enrollment, Licensing & Credentialing and is responsible for supporting all aspects of the medical licensing and credentialing processes. The Credentialing Specialist will ensure the efficient operation of medical licensing, credentialing, and payer contracts to maximize provider efficiency.

Responsibilities

• Credential/Re-credential LifeMD providers with insurance payors and/or hospitals. Maintain and update insurance credentialing and the CAQH Provider System
• Maintain credentialing matrices for all LifeMD providers and markets/states
• Provide follow-up correspondence with insurance payors on a regular basis for all credentialing matters
• Work with other LifeMD departments to facilitate the onboarding/offboarding of LifeMD providers
• Assist LifeMD providers with any ancillary credentialing, licensing or payor enrollment questions
• Obtain necessary licensure and/or privileges for LifeMD providers
• Create, maintain and update provider credentialing rosters for LifeMD
• Performs external research and conducts verification of all LifeMD licensure, malpractice and educational degrees, diplomas and certifications
• Checks insurance payor websites for accurate directory listings and performs regular updates
• Meet LifeMD expectations for payor application submission on a consistent basis

• Performs complex and confidential administrative functions including developing and typing written correspondence. Responds to routine external correspondence. Types memos, and other department forms and documents
• Handles confidential and non-routine information and maintains provider confidence and protects operations by keeping all provider and LifeMD practice information confidential
• Work independently and within a team on special and nonrecurring and ongoing projects at the request of the Director of Payor Enrollment, Licensing & Credentialing, which may include updating Excel spreadsheets or other systems, and disseminating information
• Reliability- it is an essential function of this position to report to work on time for your scheduled hours, ready for work
• Perform other related duties as required

Requirements

• Credentialing Certification, Bachelor’s Degree in Business Administration/Healthcare Administration or equivalent experience
• 2+ years of relatable experience performing credentialing and administrative functions
• Certified Provider Credentialing Specialist (CPCS), Certified Medical Services Management (CPMSM) or CPES (Certified Provider Enrollment Specialist)
• Expertise in credentialing, (multi-state) licensing and (multi-state) payor enrollment functions and processes
• Excellent analytical skills with the ability to interpret and act on complex data
• Key to have knowledge of healthcare regulations and compliance requirements
• Proficiency and ability to adapt to new credentialing software
• High level of proven communication skills, including written, verbal and conceptual presentation
• Ability to work in a fast-paced, dynamic growth environment
• Creative problem solver, strategic thinker and team player who thrives in a collaborative environment
• Fantastic organizational and time management skills with high attention to detail

Benefits

• Compensation: $60,000-$70,000 annually
• Health Care Plan (Medical, Dental & Vision)
• Retirement Plan (401k, Roth 401k)
• Life Insurance (Basic, Voluntary & AD&D)
• Flexible Paid Time Off
• Paid Holidays
• Short Term Disability
• Training & Development

Originally posted on Himalayas