Credentialing Specialist (Remote) - Payor Enrollment

PedsOne, LLC; Winooski (VT); Hybrid; USD 42,000 - 65,000; Full time

Benefits offered by this job

Private, dedicated workspace

Health, vision, dental insurance

Short-term disability

3% retirement plan matching

Job summary

PedsOne is seeking a Credentialing Specialist to support our pediatric practice clients by managing enrollment with payors and maintaining credentialing for both new and existing providers.

You will serve as a key resource for our billing team, ensuring timely credentialing, secure handling of confidential information, and ongoing communications with practice managers and payors. Remote and onsite options are available.

Qualifications

• At least 4 years of combined experience in healthcare administration including billing, compliance, or credentialing.
• A minimum of 2 years focused specifically on credentialing or payor enrollment.
• Deep understanding of medical provider credentialing principles, accreditation policies, and documentation procedures.
• Strong ability to research and stay updated on payor requirements.
• Proficiency with Google Workspace (Gmail, Drive, Docs, Sheets).
• High attention to detail, strong organizational skills, and the ability to manage time-sensitive projects independently.
• Ability to exercise independent judgment while handling confidential information securely.

Responsibilities

• Manage payor enrollment for new providers for both new and established clients.
• Maintain credentialing for existing clients and handle enrollment for new hires within the practice.
• Ensure that each provider’s CAQH profile is complete and accurate.
• Actively communicate with practice managers and stakeholders regarding the status of the credentialing and enrollment process.
• Foster professional relationships with payors or IPAs to ensure credentialing is completed within a timely manner.
• Create and maintain an internal provider database to track re-enrollment and ensure all information stays current.
• Address questions regarding contracts and credentialing as they relate to billing and reimbursement.
• Manage demographic updates, such as new practice locations.
• Stay current with industry changes and provide necessary communication and training to Account Managers.
• Collaborate closely with Account Managers and the billing team to resolve credentialing-related denials.

Skills

Experience

Industry Knowledge

Research Skills

Technical Proficiency

Soft Skills

Judgment

Tools

Google Workspace

Job description

The Credentialing Specialist (CS) supports our pediatric practice clients by managing the enrollment of new providers with payors. In this role, you will serve as a vital internal resource for our billing team, addressing all credentialing-related matters to ensure seamless operations and reimbursement.

We hire for both remote and onsite positions.

Qualifications

• Experience: At least 4 years of combined experience in healthcare administration, including billing, compliance, or credentialing. A minimum of 2 years must be specifically focused on credentialing or payor enrollment.
• Industry Knowledge: Deep understanding of medical provider credentialing principles, accreditation policies, and documentation procedures.
• Research Skills: Demonstrated ability to research and stay updated on specific requirements for various payors.
• Technical Proficiency: Strong comfort with technology, including proficiency in Google Workspace (Gmail, Drive, Docs, Sheets).
• Soft Skills: High attention to detail, strong organizational skills, and the ability to manage time-sensitive projects independently.
• Judgment: Ability to use independent judgment while managing and communicating confidential information securely.

Responsibilities

• Manage payor enrollment for new providers for both new and established clients.
• Maintain credentialing for existing clients and handle enrollment for new hires within the practice.
• Ensure that each provider’s CAQH profile is complete and accurate.
• Actively communicate with practice managers and stakeholders regarding the status of the credentialing and enrollment process.
• Foster professional relationships with payors or IPAs to ensure credentialing is completed within a timely manner.
• Create and maintain an internal provider database to track re-enrollment and ensure all information stays current.
• Address questions regarding contracts and credentialing as they relate to billing and reimbursement.
• Manage demographic updates, such as new practice locations.
• Stay current with industry changes and provide necessary communication and training to Account Managers.
• Collaborate closely with Account Managers and the billing team to resolve credentialing-related denials.

Additional Qualifications for Any Remote Work

The position is available fully remote for candidates who live beyond a reasonable commuting distance from our office in Winooski, VT. Local Vermont candidates are invited to apply for a hybrid position (3 days in office, 2 days remote).

• A private, dedicated space to ensure HIPAA compliance
• Sufficiently high speed and reliable internet service to perform the job. Download speed: optimal 10-20 mbps. Upload speed: over 5 mbps. Latency: under 50 is ideal. (Anything above 100 ms will not work.) A speed test for these metrics is available at https://speedof.me/
• Health, vision, dental insurance, and short-term disability
• CTO accrued from the 1st day of employment, beginning with 2 weeks
• 6 paid holidays with 5 additional paid days
• 3 paid days for personal emergency
• Paid time off for volunteer community service
• Paid parental leave
• Employee retirement account with 3% matching