Payor Credentialing Specialist

Eating Recovery Center; Aspen (CO); Remoto; USD 29.000 - 39.000; Tempo pieno

Vantaggi offerti da questo lavoro

Medical insurance

Paid Time Off

Tuition reimbursement

Retirement benefits

Descrizione del lavoro

ERC Pathlight is seeking a Payor Credentialing Specialist to oversee credentialing, enrollment, and privileging for physicians and allied health professionals. You will coordinate with payors and internal staff to ensure timely participation and maintain audit-ready records.

The role requires 3+ years in healthcare credentialing, strong organizational skills, and precise attention to detail. Remote-first with hybrid options for local candidates; MD Staff and CAQH systems experience is valued.

Competenze

• Must have strong organizational skills, attention to detail, and ability to multi-task in a fast-paced healthcare setting.
• Effective written and verbal communication with diverse stakeholders is required.
• Minimum of 3 years’ experience in healthcare facility credentialing and physician credentialing.

Mansioni

• Coordinate credentialing, recredentialing, and provider enrollment for physicians and allied health professionals.
• Submit credentialing and enrollment applications to Medicare, Medicaid, commercial carriers, and managed care organizations.
• Monitor application status, follow up with payors, and resolve deficiencies for timely enrollment.
• Verify licensure, education, training, certifications, work history, and malpractice coverage.
• Maintain credentialing databases (MD Staff, CAQH, PECOS, NPPES) and audit-ready files.
• Coordinate with providers and internal departments to obtain required documentation for payors.
• Research and resolve credentialing enrollment issues affecting participation and reimbursement.
• Generate credentialing reports and support internal/external audits.
• Ensure compliance with HIPAA and applicable regulations; communicate status updates to leadership.

Conoscenze

Organizational skills

Detail oriented

Multi-tasking

Written and verbal communication

Healthcare credentialing experience

Formazione

High school diploma or GED

Bachelor’s degree in business or healthcare

Strumenti

MD Staff Software

Descrizione del lavoro

Who We Are

At ERC Pathlight, we’re on a mission to change lives—and we’re looking for people who feel called to do the same.

Who We Are

At ERC Pathlight, we’re on a mission to change lives—and we’re looking for people who feel called to do the same.
As one of the nation’s leading treatment providers for eating disorders and mood, anxiety, and trauma-related conditions, we bring innovative, evidence-based, and deeply compassionate care to patients across the country.
With multiple locations nationwide and extensive virtual programming, we meet patients exactly where they are and help them move toward lasting recovery.
Founded in 2008 by renowned psychiatrists and psychologists, ERC Pathlight now supports more than 6,000 patients each year. And as the need for world-class mental health care continues to rise, our commitment is stronger than ever: to expand access, elevate the standard of care, and empower every patient to rebuild their life with dignity and hope.

Why Join Us

When you join ERC Pathlight, you become part of a team that shows up every day to make a real difference. You’ll work alongside passionate clinicians, dedicated support staff, and mission-driven leaders who believe in collaboration, growth, and doing the right thing—always.
Here, your work matters. Your ideas matter. You matter.
If you’re energized by purpose, motivated by impact, and ready to help transform the future of mental health treatment, you belong here.

Come build hope. Come save lives. Come grow with us.

What You’ll Be Doing

Schedule: This position is expected to work Monday–Friday, 8 hours per day. Candidates who are available to work during Central Time (CT/CST) business hours are preferred, though qualified candidates from other U.S. time zones who can support the required schedule will be considered.
The Payor Credentialing Specialist performs duties associated with payor enrollment, credentialing, re-credentialing, and privileging network providers.

Essential Duties And Responsibilities

• Coordinate the credentialing, recredentialing, and provider enrollment process for physicians, advanced practice providers, and allied health professionals
• Complete, review, and submit credentialing and enrollment applications to Medicare, Medicaid, commercial insurance carriers, and managed care organizations
• Monitor application status, follow up with payors, and resolve deficiencies to ensure timely provider enrollment
• Verify provider credentials, including licensure, education, training, certifications, work history, malpractice coverage, and other required documentation
• Maintain provider records in credentialing databases: MD Staff, CAQH, PECOS, NPPES, and other applicable systems, enabling tracking of credential expiration dates and maintenance of audit-ready files
• Coordinate with providers and internal departments to obtain required documentation and respond to requests from payors for additional information
• Research and resolve credentialing and enrollment issues affecting provider participation and reimbursement
• Generate credentialing reports, maintain enrollment status reports, and support internal and external audits
• Ensure compliance with federal and state regulations, accreditation standards, HIPAA, and organizational policies; communicate credentialing status updates to leadership and providers
• Participate in process improvement initiatives

Must Haves

• High school or GED (required)
• Strong organization skills. Detail oriented. Ability to multi-task and prioritize (required)
• Able to communicate in a professional manner both verbally and in writing (required)
• Minimum of 3 years of experience in healthcare facility credentialing and physician credentialing (required)

Bonus Qualities

• Bachelor’s degree in business, healthcare or any related field of study (preferred)
  • Equivalent years of experience (in addition to requirement) may be substituted for degree
• Certified Provider Credentialing Specialist (CPCS) or Certified Provider Enrollment Specialist (CPES) by the National Association of Medical Staff Services (NAMSS) (preferred)
• Experience utilizing MD Staff Software (preferred)

Location: This position is posted as remote; however, per company policy, candidates residing within a 35‑mile radius of ZIP code 80230 will be required to follow a hybrid schedule (3 days/week onsite), even if they applied to the remote posting.
This range is dependent upon candidate's state of residence, experience and market expectations.

Virtual Pay Range

$21 - $28.50 USD

What We Offer

At ERC Pathlight, caring for people is our mission and that begins with caring for our own team. Your well-being matters, and our benefit program is designed to support every part of your life.
We offer competitive compensation; comprehensive medical, dental, and vision coverage; generous Paid Time Off; Parental Leave benefits; Retirement benefits; and tuition reimbursement to help you continue growing in your career.
We also recognize that mental health is part of every person’s experience. That’s why we strive to create a workplace where you feel supported, seen, and encouraged—personally, professionally, and at home.
When you thrive, you can do your best work. And your best work changes lives.