Remote Credentialing & Enrollment Specialist II

Brightside Health Inc.; Northern (KY); Hybrid; USD 55,000 - 85,000; Full time

Benefits offered by this job

Health care coverage (medical, dental,

Pet Insurance

Life Insurance

Disability insurance

401k Plan

Unlimited PTO

Remote work

Job summary

Brightside Health is a fully remote, mission-driven company transforming mental healthcare nationwide. We seek a Credentialing & Enrollment Specialist II to manage complex credentialing and enrollment workflows with minimal supervision.

You will execute provider onboarding, submit initial and re-credentialing applications, verify credentials, maintain CAQH/PECOS profiles, and support payer enrollment across commercial and government payers while upholding NCQA standards.

Qualifications

• 3+ years of experience in credentialing and/or enrollment operations.
• Working knowledge of NCQA standards, CAQH, and payer enrollment processes.
• Experience with both commercial and government payer enrollment preferred.
• Proficiency with payer portals (CAQH, PECOS, Availity, payer-specific).
• Strong attention to detail and documentation habits.
• Ability to manage multiple priorities and meet deadlines consistently.

Responsibilities

• Execute provider onboarding readiness tasks and intake packet completeness checks.
• Prepare and submit initial credentialing and re-credentialing applications.
• Submit and monitor primary source verifications through CVO.
• Perform PSV according to NCQA standards when not completed by CVO.
• Review CVO-processed files for completeness and accuracy.
• Process provider status changes, terminations, and reactivations.
• Collect and follow up on missing provider documentation.
• Track and manage provider expirables and renewal timelines.
• Complete and submit enrollment applications to commercial and government payers.
• Follow up on submitted enrollment applications through completion.
• Maintain payer contact lists and portal access.
• Track enrollment statuses and update Salesforce accordingly.
• Manage CAQH and PECOS profile maintenance.
• Follow up on payer issue tickets and cases.

Skills

Attention to detail

Multi-tasking

Deadline-driven

Payer enrollment knowledge

NCQA knowledge

CAQH proficiency

PECOS proficiency

Availity proficiency

Payer portals

Tools

CAQH

PECOS

Availity

Job description

Brightside Health is a fully remote, mission-driven company transforming mental healthcare nationwide. We seek a Credentialing & Enrollment Specialist II to manage complex credentialing and enrollment workflows with minimal supervision.

You will execute provider onboarding, submit initial and re-credentialing applications, verify credentials, maintain CAQH/PECOS profiles, and support payer enrollment across commercial and government payers while upholding NCQA standards.