Payer Credentialing Specialist

knownwell; United States; Remote; USD 65,000 - 90,000; Full time

Benefits offered by this job

Fully remote opportunity

Medical, dental, and vision insurance

401K retirement plan with company match

Up to 20 days of PTO per year

Up to 14 weeks of parental leave

Annual work from home stipend

Job summary

A healthcare technology company is seeking a Payer Credentialing Specialist to support its Operations team. This fully remote role involves managing credentialing processes for healthcare providers and ensuring compliance with standards. The ideal candidate will have at least 2 years of experience in provider credentialing, with a strong understanding of payer enrollment processes and regulatory requirements. Benefits include comprehensive medical insurance, a 401K plan, and generous PTO.

Qualifications

• Minimum of 2 years of experience in provider credentialing and payer enrollment.
• Strong knowledge of CAQH, NPPES, PECOS, and insurance payer enrollment processes.
• Familiarity with credentialing standards from NCQA and CMS.
• High level of accuracy and attention to detail.
• Excellent communication and interpersonal skills.
• Ability to work independently, manage multiple priorities, and meet deadlines in a fast-paced environment.

Responsibilities

• Manage end-to-end credentialing processes for new and existing providers.
• Coordinate payer enrollment applications for timely processing.
• Maintain accurate credentialing files compliant with regulations.
• Collaborate with providers, health plans, and internal departments to resolve credentialing-related issues or delays.
• Track credentialing timelines and proactively follow up on outstanding applications or documentation.
• Ensure compliance with NCQA, CMS, state, and payer-specific regulations and standards.
• Participate in audits, surveys, and reporting related to provider credentialing and enrollment.
• Support cross-functional teams including clinical operations, revenue cycle, and human resources with credentialing-related information and processes.

Skills

Provider credentialing

Payer enrollment

Attention to detail

Communication skills

Tools

CAQH

NPPES

PECOS

NCQA standards

CMS guidelines

Job description

👋 Meet knownwell, weight-inclusive healthcare for all. Join a dynamic company that is changing the way obesity care is delivered. We offer weight management, primary care, nutrition counseling, and health coaching. Our care model combines in-clinic and virtual care to bring support to patients where and when they need it.

Backed by $50M in funding—including a $25M round led by CVS Health Ventures with support from a16z Bio + Health, Flare Capital, MassMutual, and Intermountain Ventures—we’re scaling fast and expanding access to evidence-based obesity care nationwide.

To achieve our ambitious goals, we're looking for a Payer Credentialing Specialist to join our Operations team. This role will support all things credentialing at knownwell, and play a critical role in building, shaping, and scaling our network so that all Americans have access to our services.

The ideal candidate is a managed care expert who has a successful track record in efficiently credentialing providers across a number of geographies. You will be most successful in this role if you have an ownership mindset, strong attention to detail, and a knack for managing multiple priorities.

You will:

• Manage end-to-end credentialing and recredentialing processes for new and existing providers, including verification of education, training, board certifications, and work history.
• Coordinate payer enrollment applications and updates to ensure timely processing and provider participation across commercial and government payers.
• Maintain accurate and up-to-date credentialing files and records in compliance with internal standards and regulatory requirements.
• Collaborate with providers, health plans, and internal departments to resolve any credentialing-related issues or delays.
• Track credentialing timelines and proactively follow up on outstanding applications or documentation.
• Ensure compliance with NCQA, CMS, state, and payer-specific regulations and standards.
• Participate in audits, surveys, and reporting related to provider credentialing and enrollment.
• Support cross-functional teams including clinical operations, revenue cycle, and human resources with credentialing-related information and processes.

You have:

• Minimum of 2 years of experience in provider credentialing and payer enrollment, preferably in a multi-state medical group or healthcare organization.
• Strong knowledge of CAQH, NPPES, PECOS, and insurance payer enrollment processes.
• Familiarity with credentialing standards from NCQA, The Joint Commission, and CMS.
• High level of accuracy and attention to detail.
• Excellent communication and interpersonal skills.
• Ability to work independently, manage multiple priorities, and meet deadlines in a fast-paced environment.

Pay & Perks:

• 💻 Fully remote opportunity
• 🩺 Medical, dental, and vision insurance
• 📈 401K retirement plan with company match
• 🏝️ Up to 20 days of PTO per year + company holidays
• 👶 Up to 14 weeks of parental leave (12 for non-birthing parents)
• 🏡 Annual work from home stipend for remote employees

knownwell, Inc. provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, and training.

We may use artificial intelligence (AI) tools to support parts of the hiring process, such as reviewing applications, analyzing resumes, or assessing responses. These tools assist our recruitment team but do not replace human judgment. Final hiring decisions are ultimately made by humans. If you would like more information about how your data is processed, please contact us.