Provider Credentialing Specialist

Virtual Rockstar; United States; Teletrabalho; USD 60 000 - 75 000; Tempo integral

Resumo da oferta

Virtual Rockstar is seeking an experienced Provider Credentialing Specialist to support U.S.-based healthcare practices on a full-time remote basis. You will manage credentialing and re-credentialing workflows, complete payer enrollments, and maintain CAQH profiles while keeping processes accurate and moving forward without gaps.

This remote role emphasizes proactive payer follow-up, multi-state credentialing knowledge, and collaboration with providers and payers to ensure timely submissions and

Qualificações

• 2+ years of hands-on provider credentialing experience
• Experience managing full credentialing workflows (submission, follow-up, re-credentialing)
• Strong knowledge of CAQH, NPI enrollment, and payer requirements
• Experience with Medicare, Medicaid, and commercial payer enrollment
• Comfortable proactive follow-up calls to payers and requesting information from providers
• Proficiency with Microsoft Office or Google Workspace

Responsabilidades

• Gather required documentation from new and existing providers to initiate credentialing
• Prepare, complete, and submit credentialing applications for new providers across commercial and government payers
• Complete re-credentialing applications and track deadlines
• Submit and track NPI and PECOS enrollment and Medicare/Medicaid applications
• Manage multi-state credentialing processes and payer-specific requirements
• Track all applications, responses, and approvals; update trackers
• Create and maintain CAQH profiles and attestations
• Perform monthly sanctions checks and keep records audit-ready
• Proactively follow up with payers via phone and email to confirm receipt and status
• Coordinate with providers to ensure documentation is complete and timely
• Serve as a point of contact for credentialing questions; escalate delays
• Manage credentialing offboarding when providers depart
• Provide light billing/AR support as needed

Conhecimentos

Attention to detail

Deadline management

English communication

Organizational skills

Ferramentas

Microsoft Office Suite

Google Workspace

Descrição da oferta de emprego

Location: United States

This is a remote position.

Rockstar is seeking an experienced Provider Credentialing Specialist to support U.S.-based healthcare practices on a full-time remote basis. This is a credentialing-first role built for professionals who understand the full provider enrollment lifecycle, from initial application through re-credentialing and payer follow-up, and who take pride in keeping processes accurate, organized, and moving forward without gaps.

In this role, you will manage provider credentialing and re-credentialing workflows, complete payer enrollments, maintain CAQH profiles, conduct sanctions checks, and serve as a reliable point of contact for providers and payers alike. Depending on the client, you may also provide light support to billing and accounts receivable functions as a secondary responsibility.

This role is ideal for someone who is detail-oriented, deadline-driven, and confident making follow-up calls to insurance payers: someone who doesn't let applications sit and knows exactly what to do when a payer goes quiet.

KEY RESPONSIBILITIES

Provider Credentialing & Enrollment

• Gather required documentation from new and existing providers to initiate credentialing
• Prepare, complete, and submit credentialing applications for new providers across commercial and government payers
• Complete re-credentialing applications as they come due and ensure submissions are made ahead of expiration deadlines
• Submit and track NPI enrollment, PECOS enrollment, and Medicare/Medicaid applications as required
• Manage multi-state credentialing processes and payer-specific enrollment requirements
• Track all active credentialing applications, submission dates, payer responses, and approval confirmations
• Save credentialing confirmations in provider files and update credentialing trackers accordingly

CAQH, Sanctions & Compliance

• Create and maintain CAQH profiles for new providers, ensuring all information is accurate and current
• Complete CAQH attestations on schedule and keep provider data up to date across all payer portals
• Perform monthly sanctions checks for all providers and document results consistently
• Maintain organized, compliant, and audit-ready credentialing records at all times
• Stay current on payer credentialing requirements, enrollment changes, and industry updates

Payer Follow-Up & Communication

• Proactively follow up with insurance payers via phone and email to confirm receipt, check application status, and resolve outstanding items
• Coordinate with providers to ensure required documentation is submitted completely and on time
• Serve as a key point of contact for credentialing-related questions from providers, payers, and internal teams
• Escalate credentialing delays or payer issues to leadership when timelines are at risk
• Maintain clear records of all payer communications, follow-up dates, and credentialing decisions

Provider Offboarding

• Manage credentialing offboarding processes when providers depart, including payer notification and record updates
• Ensure departing providers are properly removed from active payer rosters and internal trackers

Billing & Administrative Support (Where Applicable)

• Depending on the client, this role may include light support for billing and accounts receivable workflows as time allows, including claims follow-up, payer calls related to unpaid or denied claims, and general administrative coordination to keep revenue cycle operations moving.

Requirements

Required

• 2+ years of hands-on provider credentialing experience: this is not an entry-level role
• Proven experience managing full credentialing workflows: application submission, payer follow-up, re-credentialing, and documentation
• Strong working knowledge of CAQH, NPI enrollment, and payer-specific credentialing requirements
• Experience with Medicare, Medicaid, and commercial payer enrollment processes
• Comfortable making proactive follow-up calls to insurance payers and requesting information from providers
• Exceptional attention to detail and deadline management: accuracy and follow-through are essential in this role
• Strong organizational skills with the ability to manage multiple active credentialing workflows simultaneously
• Excellent written and verbal English communication skills
• Proficiency with Microsoft Office Suite (Word, Excel, Outlook) or Google Workspace
• Reliable home office setup with a stable internet connection

Preferred

• Experience credentialing Physical Therapists (PTs), Occupational Therapists (OTs), or Speech-Language Pathologists (SLPs)
• Familiarity with PECOS and CMS enrollment portals
• Experience supporting multi-provider or high-volume clinic environments, including traveling or contract providers
• Background in multi-state credentialing processes
• Familiarity with EMR or practice management platforms
• Light experience with billing or accounts receivable follow-up

WHAT WE LOOK FOR

• Ownership: you track every application from submission to approval and don't let anything sit unresolved
• Persistence: when a payer goes quiet, you follow up; you know how to navigate the system and get answers
• Precision: credentialing errors have real consequences; you catch mistakes before they become problems
• Organization: your trackers are clean, your deadlines are met, and nothing expires on your watch
• Professionalism: you communicate clearly and confidently with providers, payers, and leadership alike

Benefits

• Competitive salary commensurate with experience
• Opportunities for professional development and long-term career growth
• Work within a dynamic, collaborative, and supportive team environment
• Stable, full-time remote employment with U.S.-based clients
• Make a meaningful impact by helping businesses grow their brand and connect with the communities they serve