Remote Health Insurance Credentialing Specialist

Naukri Mitra; United States; Remote; USD 46,000 - 56,000; Full time

Benefits offered by this job

Remote work benefits

Flexible hours across time zones

Sponsored certifications

Job summary

Naukri Mitra is hiring a Remote Health Insurance Credentialing Specialist to streamline payer enrollment and provider onboarding across our national network. This role emphasizes data accuracy, regulatory compliance, and efficient workflows in a fully remote setting.

The ideal candidate has 2+ years in medical insurance credentialing, strong communication skills, and familiarity with CAQH ProView, NPPES, CHEQOS, and related databases. Remote work benefits and flexible hours are offered.

Qualifications

• Must have 2+ years of medical insurance credentialing or payer enrollment experience.
• Familiarity with CAQH, NPPES, PECOS, and other credentialing databases.
• Strong written and spoken communication in a remote work environment.

Responsibilities

• Credentialing Operations: manage end-to-end credentialing for healthcare providers across payers; verify and audit documents.
• Compliance & Regulatory: monitor adherence to NCQA, CMS, HIPAA; maintain credentialing calendar and audits.
• Communication & Stakeholder Engagement: liaise with payers, providers, and internal teams; provide status updates.
• Performance Optimization: identify inefficiencies and propose automation; use dashboards and KPIs to report progress.

Skills

Communication skills

Remote work proficiency

Attention to detail

Education

2+ years credentialing experience

Tools

CAQH ProView

Salesforce Health Cloud

Smartsheet

Zoom

Slack

Excel (PivotTables/VLOOKUP)

Job description

Remote Health Insurance Credentialing Specialist Annual Salary: $50,665

Empowering Better Health Outcomes Through Precision Credentialing

Are you prepared to contribute to an innovative healthcare company revolutionizing healthcare operations through advanced digital solutions? We seek a highly skilled Remote Health Insurance Credentialing Specialist to help us manage and streamline our insurance credentialing processes. This position is vital in maintaining the precision, compliance, and efficiency of healthcare provider onboarding and payer enrollment across our national network. Credentialing isn't just administrative—it's foundational to healthcare access, provider integrity, and patient trust. If you're passionate about transforming health data workflows into seamless, tech-powered systems, we want to hear from you.

Importance of the Role

Credentialing is a mission-critical function directly impacting provider readiness, patient experience, and revenue cycle performance. As a specialist on our credentialing team, you'll work with cutting-edge health tech platforms to process, validate, and maintain insurance credentials for our vast ecosystem of providers.

Impact Areas

• Faster provider onboarding timelines
• Increased payer acceptance rates
• Optimized billing and claims cycles
• Elevated patient trust in care quality

Key Responsibilities

• Credentialing Operations Manage end-to-end credentialing processes for healthcare providers across various payers. Collect, verify, and audit essential documents such as CAQH profiles, licensure, board certifications, malpractice insurance, etc. Ensure data accuracy using cloud-based practice management software and digital credentialing tools.
• Compliance & Regulatory Assurance Monitor adherence to NCQA, CMS, and HIPAA standards Maintain a robust credentialing calendar to track expirations and renewal timelines Perform periodic internal audits to ensure ongoing compliance.
• Communication & Stakeholder Engagement Liaise with payers, providers, and internal teams via secure messaging and VoIP platforms. Deliver credentialing status updates with clarity and precision to cross-functional stakeholders.
• Performance Optimization Identify inefficiencies and propose automation strategies Leverage credentialing dashboards and KPI trackers to report progress and highlight anomalies Participate in continuous improvement initiatives using Agile methodologies.

Tools & Technologies Used

As a fully remote credentialing professional, you will harness the power of:

• Core Software & Platforms CredentialStream for digital payer enrollment
• CAQH ProView for centralized data collection
• Salesforce Health Cloud for provider data management
• Smartsheet for task tracking and workflow automation
• Communication & Collaboration Tools Zoom & Slack for real-time collaboration
• Microsoft Excel (PivotTables, VLOOKUP) for data validation

Required Qualifications

• Must-Have Credentials & Experience 2+ years of experience in medical insurance credentialing or payer enrollment
• Strong working knowledge of Medicare, Medicaid, and major commercial insurance carriers
• Familiarity with CAQH, NPPES, PECOS, and other credentialing databases
• High level of organizational accuracy and attention to detail
• Strong proficiency in both written and spoken communication within a remote work environment

Preferred Qualifications

• CPCS or CPMSM certification
• Experience working with multi-state provider networks
• Prior use of credentialing software and cloud-based CRM systems

Work Environment and Flexibility

This position is 100% remote, designed for professionals who thrive in structured, autonomous work settings. Our distributed workforce model ensures you're empowered with:

• Remote Work Benefits Flexible work hours across time zones
• Cloud-secured access to all operational systems
• Supportive virtual onboarding and continuous learning
• Real-time chat and video collaboration for seamless communication

Company Culture and Innovation

We are proud to be pioneers in digital health operations. With a 94% credentialing approval rate within 30 days, our systems and teams are built for efficiency and excellence.

Core Cultural Values

• Continuous feedback and iteration
• Tech-forward problem-solving
• Cross-disciplinary collaboration

Career Development Opportunities

This role offers a defined path to advancement in healthcare operations. Whether you aim to specialize further in payer relations, compliance analytics, or provider lifecycle management, you’ll have access to resources and mentorship designed to elevate your career.

Growth and Learning Support

• Skill-expansion workshops
• Quarterly career mapping sessions
• Sponsored certifications and courses

Building a Global Workforce: Applications are open to professionals from the United States, Canada, United Kingdom, European Union, Australia, India, and many other international regions.