Payor Credentialing Specialist

Eating Recovery Center; Denver (CO); Híbrido; USD 29.000 - 39.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Medical, dental and vision coverage

Paid time off

Parental leave

Retirement benefits

Tuition reimbursement

Descripción de la vacante

ERC Pathlight is seeking a Payor Credentialing Specialist to manage credentialing, enrollment, and re-credentialing for physicians and allied professionals. You will ensure timely enrollment with Medicare, Medicaid, and commercial plans, maintaining enrollment records and responding to payor requests.

The role requires 3+ years in healthcare credentialing, a high school diploma or GED, and strong organizational and communication skills.

Formación

• High school or GED is required.
• Strong organizational skills, detail oriented, ability to multi-task and prioritize.
• Professional verbal and written communication is required.
• Minimum of 3 years of experience in healthcare facility credentialing and physician credentialing.
• Bachelor’s degree in business, healthcare or related field preferred (equivalent years of experience may substitute).
• Certified Provider Credentialing Specialist (CPCS) or Certified Provider Enrollment Specialist (CPES) NAMSS (preferred)

Responsabilidades

• Coordinate credentialing, recredentialing, and provider enrollment for physicians and related 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 to ensure timely enrollment.
• Verify provider credentials including licensure, education, training, certifications, work history, malpractice coverage, and other documentation.
• Maintain provider records in credentialing databases (MD Staff, CAQH, PECOS, NPPES) and track expiration dates.
• Coordinate with providers and internal departments to obtain required documentation and respond to payor requests.
• Research and resolve credentialing issues affecting participation and reimbursement.
• Generate credentialing reports, support audits, and monitor enrollment status.
• Ensure compliance with federal/state regulations, HIPAA and organizational policies; communicate status updates to leadership and providers.
• Participate in process improvement initiatives.

Conocimientos

Organizational skills

Detail oriented

Multitasking

Educación

Bachelor’s degree in business, healthcare or related field

CPCS or CPES NAMSS certification (preferred)

Herramientas

MD Staff

CAQH

PECOS

NPPES

Descripción del empleo

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)
• 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)

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 missionand that begins with caring for our own team. Your well-being matters, and our benefitprogramis designedto support every part of your life.

We offer competitive compensation; comprehensive medical, dental, and vision coverage; generous Paid Time Off; Parental Leavebenefits; 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’swhy 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.